Download PDF
Methods Inf Med 1990; 29(04): 298-307
DOI: 10.1055/s-0038-1634795
ECG Interpretation Systems
Schattauer GmbH

Evaluation of ECG Interpretation Systems: Signal Analysis

Chr. Zywietz
1   Arbeitsbereich Biosignal-verarbeitung, Medizinische Hochschule, Hannover, F.R.G
,
J. H. van Bemmel
2   Dept of Medical Informatics, Erasmus University, Rotterdam, The Netherlands
,
R. Degani
3   Ladseb-CNR, Consiglio Nazionale delle Ricerche, Padova, Italy
› Author AffiliationsPart of the results presented here were obtained during the project “Common Standards for Quantitative Electrocardiograpy” supported by the European Community 1980-1990, within the 2nd, 3rd and 4th Medical and Public Health Research Programme of DG XII.
Further Information

Publication History

Publication Date:
06 February 2018 (online)

    Permissions and Reprints

Abstract

Performance analysis of biosignal processing systems which provide diagnostic statements requires particular care. Besides general accuracy requirements, psychological and legal implications for patient and physician have to be considered on both the development and the user sites. Cybernetics and control engineering have provided the basic methodology for performance analysis of systems: in technical systems often mathematically defined functions and signals can be fed into the system to be tested and its response and output provide the necessary performance characteristics after adequate mathematical analysis. For systems which process biosignals, as for example ECG analysis systems, instead of analytically given signals learning and test sets of data derived from patients have to be applied. The performance analysis is done on a statistical basis. In this paper construction and composition of learning and test data sets as well as methods for performance evaluation of the signal pocessing part of ECG programs are described. Specific reference is made to the European project Common Standards for Quantitative Electrocardiography (CSE) where ten ECG- and nine VCG-programs have been tested. The results of these tests provide reference data and standards for further program development as well as for independent system performance evaluation.

Key-Words

ECG System Testing - Measurement Performance - Validation - Signal Processing
 

  • REFERENCES

  • 1 Waller AD. A demonstration on man of electromotive changes accompanying the heart’s beat. J Physiol 1887; 08: 229-34.
    CrossrefPubMedGoogle Scholar
  • 2 Einthoven W. Die galvometrische Registrierung des menschlichen Elektrokardio-gramms, zugleich eine Beurteilung des Anwendung des Capillar-Electrometers in der Physiologie. Pfliigers Arch 1903; 99: 472-80.
    PubMedGoogle Scholar
  • 3 Anaud DK. Introduction to Control Systems (2nd ed). Oxford: Pergamon; 1984
    Google Scholar
  • 4 Pressler G. Regelungstechnik (3. Auflage). BI Hochschultaschenbücher 63/63 a. Mannheim: Bibliogr Inst; 1967
    Google Scholar
  • 5 Zywietz Chr, Schneider B. eds. Computer Application in ECG and VCG Analysis. Amsterdam: North-Holland Publ Comp; 1973
    Google Scholar
  • 6 Van Bemmel JH, Willems JL. eds. Trends in Computer-Processed Electrocardiograms. Amsterdam: North-Holland Publ Comp; 1977
    Google Scholar
  • 7 Wolf HK, Macfarlane PW. eds. Optimization of Computer ECG Processing. Amsterdam: North-Holland Publ Comp; 1980
    Google Scholar
  • 8 Willems JL, van Bemmel JH, Zywietz Chr. eds. Computer ECG Analysis: Towards Standardization. Amsterdam: North-Holland Publ Comp; 1986
    Google Scholar
  • 9 Willems JL, Arnaud P, Degani R, Macfarlane PW, van Bemmel JH, Zywietz Chr. Protocol for the Concerted Action Project “Common Standards for Quantitative Electrocardiography”, 2nd R&D programme in the field of Medical and Public Health Research of the EEC (80/344/EEC), CSE Ref. 80-06-00. Leuven: Acco Publ; 1980
    Google Scholar
  • 10 Bailey JJ, Horton M, Itscoitz SB. A method for evaluating computer programs for electrocardiographic interpretation. III: Reproducibility testing and the sources of program errors. Circulation 1974; 50: 88-93.
    CrossrefPubMedGoogle Scholar
  • 11 Travis J. Computer-read electrocardiograms: A reproductibility study. In: Hsich RKC. ed. Automated Health Tests. US Dept Health, Education and Welfare, Publication 1730-0011. Washington DC: US Government Printing Office; 1971
    Google Scholar
  • 12 Willems JL, Pardaens J. Differences in measurement results obtained by four different ECG computer programs. In: Ostrow HG, Ripley KL. eds. Computers in Cardiology 1977. Long Beach CA: IEEE Computer Society; 1977: 115-21.
    Google Scholar
  • 13 Rautaharju PM, Ariet M, Pryor TA. et al. Task Force III: Computers in diagnostic electrocardiology. Am J Cardiol 1978; 41: 158-70.
    CrossrefPubMedGoogle Scholar
  • 14 Wolf HK, Sherwood JD, Kanon DJ. The effect of signal noise on the performance of several ECG programs. In: Ripley KL. ed. Computers in Cardiology 1976. Long Beach CA: IEEE Computer Society; 1976: 303-5.
    Google Scholar
  • 15 Willems JL. A plea for common standards in computer aided ECG analysis. Comp Biomed Res 1980; 13: 120-31.
    CrossrefPubMedGoogle Scholar
  • 16 Michaelis J, Willems JL. Performance evaluation of diagnostic ECG programs. In: Ripley KL. ed. Computers in Cardiology 1987. Long Beach CA: IEEE Computer Society; 1988: 25-30.
    Google Scholar
  • 17 Bailey JJ, Campbell G, Horton MR, Shrager RI, Willems JL. Determination of statistically significant differences in the performance of ECG diagnostic algorithms: an improved method. J Electrocardiol 1988; 21: 188-92.
    CrossrefPubMedGoogle Scholar
  • 18 Willems JL, Arnaud P, van Bemmel JH. et al. Establishment of a reference library for evaluating computer ECG measurement programs. Comp Biomed Res 1985; 18: 439-57.
    CrossrefPubMedGoogle Scholar
  • 19 Willems JL, Arnaud P, van Bemmel JH. et al. Assessment of the performance of electrocardiographic interpretation results on diagnostic accuracy. Eur Heart J 1988; 10: 1348-55.
    PubMedGoogle Scholar
  • 20 Willems JL, Arnaud P, van Bemmel JH. et al. A reference database for multilead electrocardiographic computer measurement programs. JACC 1987; 06: 1313-21.
    PubMedGoogle Scholar
  • 21 The CSE Working Party. Recommendations for measurement standards in quantitative electrocardiography. Eur Heart J 1985; 06: 815-25.
    PubMedGoogle Scholar
  • 22 Willems JL. The CSE Atlas. Ref. 83.05.13 Leuven: ACCO Publ; 1983
    Google Scholar
  • 23 Winter DA. Noise measurement and quality control techniques in recording and processing of exercise electrocardiograms. In: Blackburn H. ed. Measurement in Exercise Electrocardiography. Springfield HI: Charles C Thomas Publ; 1969: 159-68.
    Google Scholar
  • 24 Wolf H, Rautaharju PM. Assessment of accuracy of computer programs for analysis of electrocardiograms. In: Blackburn H. ed. Measurement in Exercise Electrocardiography. Springfield III: Charles C Thomas Publ; 1969: 169-79.
    Google Scholar
  • 25 Berson AS, Ferguson TA, Batchlor CD, Dunn RA, Pipberger HV. Filtering and sampling for electrocardiographic data processing. Comp Biomed Res 1977; 10: 605-16.
    CrossrefPubMedGoogle Scholar
  • 26 Zywietz Chr. Digital recording of ECG data. In: Zywietz Chr, Schneider B. eds. Computer Application on ECG and VCG Analysis. Amsterdam: North-Holland Publ Comp; 1973: 76-80.
    Google Scholar
  • 27 Wolf HK, MacInnis PJ, Stock S, Helppi RK, Rautaharju PM. The Dalhousie program. A comprehensive analysis program for rest and exercise electrocardiograms. In: Zywietz Chr, Schneider B. eds. Computer Application on ECG and VCG Analysis. Amsterdam: North-Holland Publ Comp; 1973: 231-40.
    Google Scholar
  • 28 Van Bemmel JH, Duisterhout JS, van Herpen G, Bierwolf LG. Push-button VCG/ECG processing system. In: Zywietz Chr, Schneider B. eds. Computer Application on ECG and VCG Analysis. Amsterdam: North-Holland Publ Comp; 1973: 112-30.
    Google Scholar
  • 29 Zywietz Chr, Borovsky D, Abel H. The influence of noise on ECG computer measurements and interpretations. 2nd Internat Sympos on Electrocard; Yerevan: 1973: 9.
    Google Scholar
  • 30 Alraun W, Zywietz Chr, Borovsky D, Willems JL. Methods for noise testing of ECG analysis program. In: Ripley KL. ed. Computers in Cardiology 1983. Long Beach, CA: IEEE Computer Society; 1983: 253-6.
    Google Scholar
  • 31 Rautaharju PM. Computer analysis of orthogonal and multiple scalar lead exercise electrocardiograms. In: Zywietz Chr, Schneider B. eds. Computer Application on ECG and VCG Analysis. Amsterdam: North-Holland Publ Comp; 1973: 517-30.
    Google Scholar
  • 32 Zywietz Chr, Alraun W, Willems JL. (on behalf of the CSE Working Party). Results of ECG program noise tests within the CSE Project. In: Ripley KL. ed. Computers in Cardiology 1984. Long Beach CA: IEEE Computer Society; 1984: 377-80.
    Google Scholar
  • 33 Zywietz Chr. Noise tolerance in ECG computer programs and measurement stability of minimum waves. A summary of results from CSE noise tests and conclusions. In: Willems JL, van Bemmel JH, Zywietz Chr. eds. Computer ECG Analysis: Towards Standardization. Amsterdam: North-Holland Publ Comp; 1986: 87-95.
    Google Scholar
  • 34 Zywietz Chr, Willems JL, Arnaud P, Degani R, van Bemmel JH, Macfarlane P. Stability of ECG amplitude measurements in systematic noise tests, preliminary resuits from the CSE Project. In: Ripley K. ed. Computers in Cardiol 1987. Washington DC: IEEE Computer Society; 1987: 243-6.
    Google Scholar
  • 35 Zywietz Chr, Willems JL. Stability of ECG amplitude measurements in systematic noise tests. Results and recommendations from the CSE Project. J Electrocardiol 1987; 61-7.
    PubMedGoogle Scholar
  • 36 Willems JL, Zywietz Chr, Arnaud P, van Bemmel JH, Degani R, Macfarlane PW. Influence of noise on wave boundary recognition by ECG measurement programs. Comp Biomed Res 1987; 20: 543-62.
    CrossrefPubMedGoogle Scholar
  • 37 Zywietz Chr, Willems JL, Arnaud P, van Bemmel JH, Degani R, Macfarlane PW. Stability of compurter ECG amplitude measurements in the presence of noise. Comp Biomed Res 1990; 23: 10-31.
    CrossrefPubMedGoogle Scholar
  • 38 Ripley KL, Oliver GC. Development of an ECG database for arrhythmia detector evaluation. In: Ostrow HG, Ripley KL. eds. Comp in Cardiol.. Long Beach CA: IEEE Computer Society; 1977: 203-9.
    Google Scholar
  • 39 Mark RG, Moody GB. Evaluation of automated arrhythmia monitors using an annotated ECG database. In: Marchesi E. ed. Ambulatory Monitoring. The Hague: Martinus Nijhoff Publ; 1984
    Google Scholar