[原著]心電図電話伝送同時自動解析システムの老人検診への応用と問題点

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Computer analysis of ECG has been in practice for some years, though with many difficulties. Telephone transmission of ECG has been attempted for the purpose of detection and ascertainment of emergency cases in several communities. The former and the latter, however, have independtly been developed, without any direct relations. In order to cope with all the cardiac emergencies and to maintain a satisfactoryhealth care of the communities especially in the distant and isolated islands of Okinawa, it is considered to be essential that these two individual systems be closely connected. The many problems that arise from the direct linkage of these two systems are different from the conventional ones encountered within the individual systems. Calibrations and normal ECG patterns have so far been successfuly transmitted and simultaneously analyzed. The trial reported here was to apply the connected systems to the many varieties of abnormal ECG patterns of 88 elderly people in the aged illness facility, Kaiseien. A certain number of false positive cases can be tolerated, though the fewer the false positive cases there are, the better the diagnosis will be. However, the false negative should be completely eliminated since it can lead to a fatal condition. One false negative diagnosis appeared out of seventeen cases of myocardial infarction which was caused by a failure of the system to react to spikes below 0.2 mv. Adequate sensitivity is necessary for wave recognition in the system. If it were hypersensitive, far more false positive cases would appear as it picked up contaminated myopotentials. Underestimation of high R waves above 2.6 mV was the cause for overlooking of left ventricular hypertrophy. Two kinds of factors can be considered as the cause : the management of these systems and mechanical interfaces before the computer stage. The former could be solved by decreasing the gain before hand in high R waves in the terminal station. But the latter, it is inferred, is caused by the difference of high cut filters of the sound coupler for the receiver and of the interface. The undecidable cases were frequently found and many of them were considered to be due to the inability of the system to decide the base line. Consequently another way of deciding the base line should be adopted in addition to the T-P standard line method. It can be stated that this linkage system is fairly adequate to cover the chronic condition of elderly patients, but improvements must be introduced in the management of the system, in the accuracy of mechanical linkage, and in the diagnostic logic so that the goal of monitoring emergency cases may be attained.

[原著]心電図電話伝送同時自動解析システムの老人検診への応用と問題点

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