Electrocardiography (ECG) may be able to detect potential digoxin toxicity based on characteristic presentations. However, the standard input format of ECG12Net is a length of 1024 numeric sequences. ; Geraci, S.A.; Horwich, T.; Januzzi, J.L. eCollection 2022. and C.-S.L. A total of 177,127 ECGs were enrolled in the study (, The consistency analysis of the human-machine competition for digoxin toxicity risk prediction by ECG reading is shown in, ECGs in the first quadrant revealed typical characteristics of digoxin toxicity in high-risk cases, such as concave or down-sloping ST-T depression at the inferior and lateral leads, diminished T wave height, and bradycardia with AF with a slow ventricular response. Epub 2022 Mar 15. ; Filippatos, G.S. Over the past several days, the patient has had increasing confusion, weakness, malaise, and anorexia. methods, instructions or products referred to in the content. In order to be human-readable, please install an RSS reader. Queens of the Stone Age will bring Phantogram, Viagra Boys, the Armed, and Savages' Jehnny Beth on their fall North American tour. In this study 137 patients were included, and 68.6% of patients were women with mean age 76.112.2. The results are demonstrated in. The AUCs of our deep learning system for identifying digoxin toxicity were 0.912 and 0.929 in the validation cohort and the human-machine competition, respectively, which reached 84.6% of sensitivity and 94.6% of specificity. Keywords: MDPI and/or ; Kadhiravan, T.R.S. Digoxin is a commonly prescribed drug in the management of heart failure and atrial fibrillation. All analyses were based on ECGs from the patients. ; Ruiz, F.C. Importantly, only eight patients with HF and four patients without AF were included in the validation set for stratified analysis, which accounts for 100% of sensitivity, instead of overfitting of the data. Lee YT, Lin CS, Fang WH, Lee CC, Ho CL, Wang CH, Tsai DJ, Lin C. Front Cardiovasc Med. Our ECG-based deep learning system provides a high-accuracy, economical, rapid, and accessible way to detect digoxin toxicity, which can be applied as a promising decision supportive system for diagnosing digoxin toxicity in clinical practice. Digoxin toxicity can present acutely after . Rahimtoola, S.H. She experienced intermittent episodes of hypotension and was deemed to be hemodynamically unstable andwas administered (3.2 * 90-kg/100)= ~3 vials of Fab. All 13 digoxin toxicity ECGs in the validation cohort were included, and 52 normal ECGs in the validation cohort were randomly selected for the human-machine competition. The relationship between elevated digoxin levels and comorbid diseases. There are two classical clinical scenarios associated with digitalis toxicity: the acute intoxication and the chronic intoxication. Photo: Andreas Neumann. Milea, D.; Najjar, R.P. [1] In therapeutic doses, digoxin increases cardiac contractility and controls the heart rate. sharing sensitive information, make sure youre on a federal Treatment includes digoxin-specific antibody fragments and supportive care. https://doi.org/10.3390/ijerph18073839, Subscribe to receive issue release notifications and newsletters from MDPI journals, You can make submissions to other journals. NCI CPTC Antibody Characterization Program, Ponikowski P., Voors A.A., Anker S.D., Bueno H., Cleland J.G.F., Coats A.J.S., Falk V., Gonzalez-Juanatey J.R., Harjola V.P., Jankowska E.A., et al. Below, check out the tour dates, as well as a weird tour . Densely Connected Convolutional Networks. EWB declares that he has no competing interests. However, previous studies disclosed 23.95% and 60.8% sensitivities of digoxin toxicity identified by human ECG readings [. Past ECGs could not be found for 16 (16.6%) patients. Circulation. We concluded that digoxin intoxication must be suspected in patients presenting to the ED, particularly those complaining of nausea and vomiting and exhibiting new electrocardiographic changes. No significant difference was found between digoxin intoxication and gender. We defined 5 or more of the 9 clinicians answers as human answers in the human-machine competition. official website and that any information you provide is encrypted Digitalis Therapy for Patients in Clinical Heart Failure. The settings for the training model were as follows: (1) Adam optimizer with standard parameters (1 = 0.9 and 2 = 0.999) and a batch size of 50 for optimization; (2) learning rate was set at 0.001; and (3) a weight decay of 10, Because the sampling rate of our machine is 500 Hz, our 12-lead ECG signal includes 12 numeral sequences with 5000 digits. The means were compared using Student's t-test or the MannWhitney U-test as applicable after verifying normality using the KolmogorovSmirnov test. The demographic and clinical characteristics of patients with serum digoxin levels at or above 1.2ng/ml admitted to an ED between January 2010 and July 2011 were investigated in this cross-sectional descriptive study. Int. Performance comparison in digoxin toxicity, Performance comparison in digoxin toxicity recognition in the human-machine competition. Meanwhile, Leads aVL and V6 have the second- and the third-best predictive abilities, with AUCs of 0.928 and 0.918, respectively. 2004 May;22(3):235-6. doi: 10.1016/j.ajem.2004.02.034. 2013 Apr 15;164(3):365-7. doi: 10.1016/j.ijcard.2011.07.034. In the intoxicated group, the treatment modalities were assessed. 1996-2023 MDPI (Basel, Switzerland) unless otherwise stated. SDC may be dynamic, which is confounded by several comorbidities, including acute kidney injury, low cardiac output, or concomitant use of other drugs [, The epidemiology of digoxin toxicity accounts for about 1% of patients with congestive HF who are treated with digoxin [, Artificial intelligence (AI) has been extensively applied in the biomedical fields, including cardiovascular risk prediction, and it automates diagnosis of eye diseases, reviews pathological slides, and triages urgent findings in head CTs [, The Tri-Service General Hospital, Taipei, Taiwan, provided the research data from November 2011 to February 2019. For the second half of the tour, QOTSA will join forces with likeminded spirits Viagra Boys and with former Savages leader Jehnny Beth. The AUCs of our deep learning system for identifying digoxin toxicity were 0.912 and 0.929 in the validation cohort and the human-machine competition, respectively, which reached 84.6% of sensitivity and 94.6% of specificity. government site. "Detecting Digoxin Toxicity by Artificial Intelligence-Assisted Electrocardiography" International Journal of Environmental Research and Public Health 18, no. However, there was no significant difference between two groups relative to the final clinical courses (Chi-square:0.39; p=0.82). The Na-K-ATPase and calcium-signaling microdomains. Final report of a multicenter study. There are differences between the ECG findings in various studies. 2014;130:20712104. The site is secure. (, Lead-specific ROC (Receiver operating characteristic) curves in the validation cohort. See this image and copyright information in PMC. In Proceedings of the 32nd International Conference on International Conference on Machine Learning, Lille, France, 611 July 2015. We tried to include more clinical information, such as patient characteristics and laboratory test, to improve the model performance. ? ECG Features of Digoxin Toxicity The classic digoxin toxic dysrhythmia combines: Supraventricular tachycardia (due to increased automaticity) Slow ventricular response (due to decreased AV conduction) Other common dysrhythmias associated with digoxin toxicity include: Association of serum digoxin concentration and outcomes in patients with heart failure. List the treatment and management options available for digitalis toxicity. AF with slow ventricular rates, sinus bradycardia and PVCs were significantly more common in intoxicated patients, while AF with a rapid ventricular rate was significantly more common in non-intoxicated patients (Table4). 8600 Rockville Pike Scientific Document. Extremities have 1+ pitting edema. ; et al. Digitalis Glycosides. February 21, 2022 Management of Digoxin Toxicity Written by Santiago Lopez, MD, Katrina D'Amore, DO, John Kashani DO REBEL Core Medical Category: Toxicology A 78-year-old woman is brought in by EMS after her husband called 911 for increased confusion associated with intractable vomiting. Epub 2011 Jul 31. Although these other toxins are clinically similar, this topic specifically discusses toxicity from digoxin. Plasma Digoxin Concentrations in Patients with Atrial Fibrillation. Probable clinical findings other than cardiac findings. It has inotropic effects and is utilized in the management of systolic dysfunction in patients with congestive heart failure (CHF) and as an atrioventricular nodal blocking agent for managing atrial tachydysrhythmias. Digoxin. Introduction. The multivariable logistic regression model was used to integrate the deep learning model and clinical information. These results remind us of the potential diagnostic difficulties in patients with AF and/or without HF when we apply our DLM in the detection of digoxin toxicity. A new deep learning algorithm of 12-lead electrocardiogram for identifying atrial fibrillation during sinus rhythm. Antman, E.M.; Wenger, T.L. Careers, Unable to load your collection due to an error. Haynes etal reported a decrease in digoxin intoxication related to the decreased use of digoxin between 1994 and 2004 in the USA.5 The American Association of Poison Control Centers reported 2610 toxic digoxin exposures in 2006, and this number was 2550 in 2009.9 Budnitz etal found that every arrival to the ED was drug related among patients more than 65 years old. Digoxin toxicity is a clinical diagnosis that relies in part on ECG findings such as signs of increased automaticity and atrioventricular node blockade (premature ventricular contractions, slowed ventricular response). ECG findings for intoxicated and non-intoxicated patients. 2022 Aug;33(8):1932-1943. doi: 10.1111/jce.15440. Manifestations of life-threatening toxicity of digoxin overdose such as severe ventricular arrhythmias, progressive bradycardia, and second or third degree heart block not responsive to atropine, serum potassium levels exceeding 5.5 mEq/L in adults or 6 mEq/L in children with rapidly progressive signs and symptoms of digoxin toxicity. Stratified analysis showed that our deep learning system was more applicable to patients with heart failure (HF) and without atrial fibrillation (AF) than those without HF and with AF. 2022 Jun 13;9:895201. doi: 10.3389/fcvm.2022.895201. We found that type of exposures had a significant effect on blood digoxin levels but had no effect on any other laboratory parameters. Chest radiograph of the patient on presentation shows the features of congestive heart, 12-lead ECG shows (a) atrial fibrillation at baseline; and (b) frequent ventricular ectopic, Predisposing conditions for digoxin toxicity:(4,13,14), Signs and symptoms of digoxin toxicity in each system:(4), MeSH ; Jessup, M.; Bozkurt, B.; Butler, J.; Casey, D.E., Jr.; Colvin, M.M. They were compared using either Students. ; et al. NCO made substantial contributions to the design, the analysis and interpretation of data, and was involved in drafting the manuscript. Unauthorized use of these marks is strictly prohibited. eCollection 2023 Jan. Petmezas G, Stefanopoulos L, Kilintzis V, Tzavelis A, Rogers JA, Katsaggelos AK, Maglaveras N. JMIR Med Inform. Sharing sensitive information, such as patient characteristics and laboratory test, to the... The past several days, the treatment and management options available for digitalis:. 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