北京生物醫(yī)學(xué)工程

評價智能心電檢測儀診斷心律失常的準(zhǔn)確性

Diagnostic accuracy of intelligent electrocardiogram monitor in the diagnosis of arrhythmia

作者：周和徐亞偉

單位：同濟(jì)大學(xué)醫(yī)學(xué)院全科醫(yī)學(xué)系（上海 200092） 上海市徐匯區(qū)凌云街道社區(qū)衛(wèi)生服務(wù)中心全科（上海 200237） 上海市第十人民醫(yī)院心內(nèi)科（上海 200092） 通信作者：周和。E-mail：[email protected]

關(guān)鍵詞：心電監(jiān)護(hù)；心律失常；診斷準(zhǔn)確性；人工智能；遠(yuǎn)程預(yù)警

分類號：R318.04

出版年·卷·期（頁碼）：2022·41·1（73-78）

摘要：

目的評價智能手機(jī)APP操作的單導(dǎo)聯(lián)手持心電檢測儀(智能1L-ECG)在心房顫動( atrial fibrillation ,AF) 、心房撲動 ( atrial flutter ,AFL)等心律失常篩查中的準(zhǔn)確性，探討其人工智能算法和遠(yuǎn)程預(yù)警的優(yōu)勢。方法選擇2019年11月至2020年9月上海市徐匯區(qū)凌云街道65歲以上自愿接受12L-ECG診斷和智能1L-ECG的體檢患者375例。采用隨機(jī)原則由2位不同醫(yī)生分別完成12L-ECG及智能1L-ECG的操作。智能1L-ECG采集的圖譜由智能集成算法和盲法的心臟病專家評估。結(jié)果最終納入了350例老年患者，年齡為（71.68±5.14）歲，女性占57.1%。智能1L-ECG的智能算法對診斷AF/AFL的受試者工作曲線下面積（area under curve，AUC）為0.851（95%CI，0.649—1），靈敏度、特異度、準(zhǔn)確度、陽性似然比和陰性似然比分別為71.4%、98.8%、98.3%、59.5、0.29。心臟病專家診斷AF/AFL的AUC為0.927（95%CI，0.774—1），靈敏度、特異度、準(zhǔn)確度、陽性似然比和陰性似然比分別為85.7%、99.7%、99.4%、285.7、0.14；對其他心律異常的AUC為0.791（95%CI，0.719—0.863），靈敏度、特異度、準(zhǔn)確度、陽性似然比和陰性似然比分別為85.7%、99.7%、99.4%、285.7、0.14；對房室傳導(dǎo)阻滯的AUC為0.853（95%CI，0.709—0.996），靈敏度、特異度、準(zhǔn)確度、陽性似然比和陰性似然比分別為71.4%、99.1%、98%、79.3、0.29。結(jié)論智能1L-ECG的智能算法對AF/AFL和房室傳導(dǎo)阻滯具有較高的診斷價值，能用于診斷房顫等心律失常，提高篩檢率。

Objective To evaluate the accuracy of a smart phone-operated applications, single-lead ECG monitor (intelligent 1L-ECG) in screening of atrial fibrillation(AF)/ atrial flutter(AFL) and other arrhythmias, and explore the advantages of its intelligent artificial algorithm and remote warning. Methods A total of 375 patients over 65 years old who voluntarily received 12L-ECG and intelligent 1L-ECG from Nov. 2019 to Sep. 2020 were selected from Lingyun Street, Xuhui District, Shanghai. All intelligent 1L-ECG atlas of electrocardiograms which were collected through smart phone-operated apps were estimated by blinded cardiologists as well as by the smart phone-integrated algorithm.Results We identified a total of 350 elderly patients in Shanghai. Mean±SD age was 71.68 ± 5.14 years, and 57.1% of the patients were female. The algorithm for intelligent 1L-ECG to diagnose AF / AFL achieved an area under the receiver operating curve (AUC) of 0.851 (95% CI, 0.649 to 1) with sensitivity, specificity, accuracy,positive likelihood ratio(+LR) and negative likelihood ratio(-LR) of 71.4%,98.8%,98.3%,59.5 and 0.29 respectively,while the cardiologists to diagnose AF / AF had an AUC of 0.927 (95% CI, 0.774 to 1) with sensitivity, specificity, accuracy,+LR and -LR of 85.7%,99.7%,99.4%,285.7 and 0.14 respectively.The cardiologists to diagnose other arrhythmias had an AUC of 0.791（95%CI，0.719 to 0.863）with sensitivity, specificity, accuracy,+LR and -LR of 85.7%,99.7%,99.4%,285.7 and 0.14 respectively.and diagnose atrioventricular block (AV block) had an AUC of 0.853（95%CI，0.709 to 0.996）with sensitivity, specificity, accuracy,+LR and -LR of 71.4%,99.1%,98%,79.3 and 0.29 respectively.Conclusions The algorithm of intelligent 1L-ECG has high diagnostic value for AF /AFL and AV block. It can be used to diagnose arrhythmias such as atrial fibrillation and improve the screening rate.

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