Annals of Noninvasive Electrocardiology最新文献

{"title":"Acute Coronary Syndrome Linked to Massive Coronary Artery Aneurysms as Late Complications of Kawasaki Disease: A Case Report","authors":"Halime Tanrıverdi,&nbsp;Elif Durak Ediboğlu","doi":"10.1111/anec.70223","DOIUrl":"10.1111/anec.70223","url":null,"abstract":"<p>Kawasaki disease (KD) is an acute childhood vasculitis that may cause late coronary complications. We report a 25-year-old man with childhood KD who presented with acute coronary syndrome without conventional cardiovascular risk factors. High-sensitivity troponin T was elevated, and transthoracic echocardiography showed regional wall motion abnormalities with reduced left ventricular ejection fraction. Coronary angiography revealed subtotal ostial left anterior descending artery stenosis with a giant aneurysm and a giant right coronary artery aneurysm. The heart team decided to proceed with coronary artery bypass grafting. Clinicians should consider late KD-related sequelae in young adults with acute coronary syndrome.</p>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 4","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13403474/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148590221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Resting Heart Rate Alone May Not Fully Capture Electrocardiographic Risk in Women With INOCA","authors":"Cem Korucu,&nbsp;Bülent Görenek","doi":"10.1111/anec.70214","DOIUrl":"10.1111/anec.70214","url":null,"abstract":"&lt;p&gt;We read with great interest the article by Dungan et al. investigating electrocardiographic predictors of major adverse cardiovascular events (MACE) in women with ischemia and no obstructive coronary artery disease (INOCA). The authors should be congratulated for addressing an important and increasingly recognized cardiovascular condition and for identifying resting heart rate (RHR) as an independent predictor of adverse outcomes.&lt;/p&gt;&lt;p&gt;Nevertheless, several issues deserve further discussion.&lt;/p&gt;&lt;p&gt;First, although RHR emerged as the only electrocardiographic predictor in the final multivariable model, the observed effect size was relatively modest. While statistically significant, RHR may represent a surrogate marker reflecting autonomic dysfunction, systemic inflammation, physical conditioning, or medication effects rather than a direct indicator of electrical instability. Previous large-scale studies have demonstrated an association between elevated resting heart rate and cardiovascular mortality; however, the incremental prognostic value beyond established clinical and electrocardiographic variables remains debated (Benetos et al. &lt;span&gt;1999&lt;/span&gt;; Zhang et al. &lt;span&gt;2016&lt;/span&gt;).&lt;/p&gt;&lt;p&gt;Second, earlier analyses from the Women's Ischemia Syndrome Evaluation (WISE) cohort identified several electrocardiographic markers, including prolonged QTc interval, widened QRS duration, and abnormal QRS-T angle, as predictors of adverse cardiovascular outcomes (Triola et al. &lt;span&gt;2005&lt;/span&gt;; Mehta et al. &lt;span&gt;2017&lt;/span&gt;). The lack of significance of these parameters in the present analysis may reflect differences in model construction, endpoint definitions, or statistical power and warrants further clarification.&lt;/p&gt;&lt;p&gt;Third, contemporary electrocardiographic risk assessment extends beyond conventional intervals and rhythm analysis. Emerging markers such as fragmented QRS, Tpeak–Tend (Tp-e) interval, Tp-e/QT ratio, and P-wave dispersion have been associated with ventricular arrhythmogenesis, autonomic dysfunction, myocardial fibrosis, and adverse cardiovascular outcomes in various clinical settings (Das et al. &lt;span&gt;2006&lt;/span&gt;; Gupta et al. &lt;span&gt;2008&lt;/span&gt;; Kors et al. &lt;span&gt;1998&lt;/span&gt;; Dilaveris and Gialafos &lt;span&gt;2001&lt;/span&gt;). Incorporating these parameters may provide additional mechanistic insight into risk stratification among women with INOCA.&lt;/p&gt;&lt;p&gt;Finally, coronary microvascular dysfunction and autonomic dysregulation are increasingly recognized as central mechanisms in INOCA. Future studies integrating advanced electrocardiographic markers with coronary functional testing and multimodality imaging may improve prognostic assessment beyond resting heart rate alone.&lt;/p&gt;&lt;p&gt;We congratulate the authors for their valuable contribution and believe that further exploration of novel electrocardiographic markers may refine risk stratification in this challenging population.&lt;/p&gt;&lt;p&gt;C.K. conceived the idea for the manuscript, performed the literature","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 4","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70214","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148444041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Critical Appraisal of Self-Supervised Contrastive Pretraining for Extreme Few-Shot ECG Classification","authors":"Faizan Ahmed,&nbsp;Ahmed Raza,&nbsp;Abdullah Aman,&nbsp;Hamza Tahir","doi":"10.1111/anec.70216","DOIUrl":"10.1111/anec.70216","url":null,"abstract":"&lt;p&gt;We read with great interest the article by Zeng et al. (&lt;span&gt;2026&lt;/span&gt;) investigating the role of self-supervised learning (SSL) in stabilizing extreme few-shot electrocardiogram (ECG) classification. The authors should be commended for shifting attention from conventional performance metrics toward training stability and reproducibility, issues that are increasingly recognized as critical barriers to the clinical translation of artificial intelligence (AI) systems. Nevertheless, we would like to highlight several methodological considerations that may influence the interpretation of the reported findings.&lt;/p&gt;&lt;p&gt;First, conclusions regarding model stability and collapse prevention rest on only three random seeds per condition, whereby the reported 66.7% collapse rate reflects merely two failed runs, a sample too limited to yield robust or reproducible stability estimates. Given well-established variability in deep learning performance across initializations, substantially more repetitions are warranted to reliably characterize training stability and avoid overinterpreting chance findings. Previous studies have emphasized extensive repeated experimentation and variability assessment to ensure robust evaluation of model performance and stability (Renard et al. &lt;span&gt;2020&lt;/span&gt;).&lt;/p&gt;&lt;p&gt;Second, the absence of formal statistical hypothesis testing, including confidence intervals, bootstrap analyses, or permutation testing, means observed differences in Macro-F1 scores and optimization behavior between training strategies cannot be reliably distinguished from random variation inherent to small-sample experiments. Incorporating appropriate statistical comparisons is essential to substantiate claims of SSL superiority over conventional approaches. Prior ECG-AI studies have routinely reported confidence intervals and formal comparative analyses to distinguish meaningful improvements from random variation (Ribeiro et al. &lt;span&gt;2020&lt;/span&gt;).&lt;/p&gt;&lt;p&gt;Third, the novel definition of training collapse based on the best validation epoch occurring at or before the first training epoch lacks independent validation as a surrogate for optimization failure. Given that the study's primary conclusions rest heavily on collapse rate reductions, supplementary indicators such as prediction entropy, calibration behavior, or class-distribution collapse are needed to confirm that the observed phenomenon reflects genuine model collapse rather than an artifact of metric selection. Previous investigations of optimization behavior and training dynamics have generally relied on established theoretical and empirical indicators of learning stability rather than newly introduced thresholds (Sutskever et al. &lt;span&gt;2013&lt;/span&gt;).&lt;/p&gt;&lt;p&gt;Finally, the absence of comparisons with contemporary few-shot learning frameworks including transfer-learning pipelines, metric-based learning, meta-learning, and alternative semi-supervised strategies limits the study's conclusions to SSL outperform","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 4","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70216","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148374322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interpreting ECG-Based Risk Stratification in Women With INOCA: Methodological Considerations From the WISE Cohort","authors":"Muhammet Cihat Çelik","doi":"10.1111/anec.70202","DOIUrl":"10.1111/anec.70202","url":null,"abstract":"&lt;p&gt;We read with great interest the recent study by Dungan et al. evaluating electrocardiographic predictors of major adverse cardiovascular events (MACE) among women with suspected ischemia and no obstructive coronary artery disease (INOCA) from the Women's Ischemia Syndrome Evaluation cohort (Dungan et al. &lt;span&gt;2026&lt;/span&gt;). The authors identified resting heart rate as an independent predictor of incident composite MACE and highlighted its potential role as a clinically accessible risk marker. Given the increasing recognition of INOCA as a clinically relevant condition, the study represents an important contribution to sex-specific cardiovascular risk stratification. However, several methodological aspects deserve further clarification to better contextualize the clinical implications of these findings.&lt;/p&gt;&lt;p&gt;The magnitude of association between resting heart rate and MACE appears modest, with a hazard ratio close to unity despite statistical significance. Such small effect sizes may reflect residual confounding or composite endpoint sensitivity rather than a robust independent prognostic signal. Prior large-scale cohort analyses have demonstrated that resting heart rate is associated with cardiovascular and all-cause mortality primarily when interpreted within broader cardiometabolic and autonomic frameworks rather than as a standalone predictor (Lonn et al. &lt;span&gt;2014&lt;/span&gt;). Therefore, caution is warranted before translating these observations into clinical decision-making algorithms specific to INOCA populations.&lt;/p&gt;&lt;p&gt;Another important consideration relates to the heterogeneity of the composite MACE endpoint used in the study. Inclusion of angina-related hospitalization alongside hard endpoints such as myocardial infarction, stroke, and death may increase event counts but potentially reduces prognostic specificity. Previous longitudinal analyses of women with INOCA have shown that outcome interpretation varies substantially depending on endpoint composition and follow-up duration, particularly when symptom-driven hospitalizations are incorporated into composite cardiovascular outcomes (Jespersen et al. &lt;span&gt;2012&lt;/span&gt;). Stratified analyses separating hard and soft endpoints might therefore provide additional insight into the independent contribution of electrocardiographic markers.&lt;/p&gt;&lt;p&gt;Medication exposure immediately prior to ECG acquisition also represents a potential source of confounding. In particular, nitrate use within 24 h before ECG recording emerged as an independent predictor in the multivariable model, raising the possibility that resting heart rate may partly reflect treatment intensity or baseline symptom burden rather than intrinsic autonomic risk signaling. Previous investigations of INOCA cohorts have emphasized the complex interaction between symptom severity, therapeutic exposure, and outcome risk, suggesting that treatment-related variables may act as surrogate markers rather than causal predictors (Mehta et al. &lt;sp","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 4","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70202","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148366701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Unusual Etiology of Bayés' Syndrome: Fabry Disease","authors":"Nicholas E. Kunce,&nbsp;Andre Silva,&nbsp;Mark Haigney,&nbsp;Adam Kisling","doi":"10.1111/anec.70220","DOIUrl":"10.1111/anec.70220","url":null,"abstract":"<p>We present the case of a 72-year-old female with Fabry disease who developed an advanced interatrial conduction block and atrial fibrillation, a condition known as Bayés' syndrome. Fabry disease is an X-linked inherited lysosomal storage disorder that results in the accumulation of globotriaosylceramide in various organs, including the heart. While this condition has been shown to cause cardiac conduction disease, Bayés' syndrome as a result of Fabry disease has not been reported in the literature. This case report suggests that Fabry disease may precipitate atrial cardiomyocyte damage at Bachmann's bundle leading to interatrial block and supraventricular arrhythmia.</p>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 4","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70220","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148366725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Critique on Integrated Heart Sound-Electrocardiogram Synchronization System for Early Detecting Left Ventricular Systolic Dysfunction in Pediatric Populations","authors":"Shahzadi Gulfishan,&nbsp;Ahmed Raza,&nbsp;Abdullah Aman","doi":"10.1111/anec.70218","DOIUrl":"10.1111/anec.70218","url":null,"abstract":"&lt;p&gt;We read with great interest the study by Gao et al. (&lt;span&gt;2026&lt;/span&gt;) recently published in &lt;i&gt;Annals of Noninvasive Elecrocardiology&lt;/i&gt;, investigating the diagnostic utility of cardiac acoustic biomarkers, including electromechanical activation time (EMAT) and its corrected index (EMATc) for detecting left ventricular systolic dysfunction (LVSD) in a pediatric population. This work represents a commendable and timely contribution to the field, addressing a genuine clinical need for non-invasive, accessible tools in pediatric cardiac assessment. The authors are to be congratulated for applying acoustic cardiography in this underexplored demographic, where conventional diagnostic modalities may be limited by feasibility, cost, and patient cooperation. However, several methodological limitations warrant consideration before these findings can be translated into broader clinical practice.&lt;/p&gt;&lt;p&gt;First, the single-center design and absence of external validation represent a fundamental methodological limitation. Diagnostic cutoffs for EMATc (11.8%) and EMAT (82.5 ms) were derived and evaluated within the same cohort, risking overfitting and spectrum bias that may inflate reported AUC, sensitivity, and specificity. These thresholds may not generalize across diverse ethnic backgrounds, healthcare settings, disease etiologies, or equipment platforms. Kosmicki et al. (&lt;span&gt;2010&lt;/span&gt;) emphasized that acoustic cardiography findings require validation across broader clinical populations before widespread implementation. Second, the absence of test–retest and interobserver reproducibility assessment is a significant limitation. High diagnostic accuracy does not guarantee reproducibility, and without reliability testing, observed differences in EMAT and related parameters may reflect measurement variability rather than true physiologic change. Gupta et al. (&lt;span&gt;2008&lt;/span&gt;) emphasized reproducibility as essential when interpreting heart-sound derived parameters. Third, the absence of reported signal quality indices, noise rejection rates, or exclusion proportions limits reproducibility assessment. Pediatric recordings are particularly vulnerable to movement artifacts, crying, and respiratory noise, which can distort EMAT measurements and affect diagnostic accuracy. Wen et al. (&lt;span&gt;2014&lt;/span&gt;) highlighted signal quality as a primary determinant of reliability in acoustic cardiography. Fourth, reliance on LVEF alone as the reference standard is a notable limitation, as LVEF is load-dependent and may miss subclinical myocardial dysfunction despite abnormal mechanics, risking patient misclassification. Reant et al. (&lt;span&gt;2010&lt;/span&gt;) demonstrated that systolic time intervals correlate with myocardial functional parameters beyond conventional ejection fraction. Finally, grouping all children with LVEF &lt; 55% into a single LVSD category without etiologic stratification is a meaningful limitation. Dilated cardiomyopathy, myocarditis, congenital heart","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 4","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70218","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148343795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electrocardiographic Repolarization Changes Following Orchiectomy: Insights Into QT Interval Prolongation and Clinical Implications","authors":"Yuta Sakaguchi,&nbsp;Kenichi Iijima,&nbsp;Naomasa Suzuki,&nbsp;Takahiro Hakamata,&nbsp;Yasuhiro Ikami,&nbsp;Sou Otsuki,&nbsp;Nobue Yagihara,&nbsp;Daisuke Izumi,&nbsp;Takayuki Inomata","doi":"10.1111/anec.70217","DOIUrl":"10.1111/anec.70217","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Sex steroid hormones influence ventricular repolarization and QT interval duration. Testosterone has been associated with shorter QT intervals, whereas androgen deprivation may prolong repolarization indices. However, the effects of orchiectomy on ECG parameters in humans remain insufficiently characterized.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective analysis of 233 consecutive patients who underwent orchiectomy at our hospital between 2006 and 2021. ECG parameters were compared in 44 patients who had ECG recorded both before and after surgery. Furthermore, the effects of surgery were stratified by unilateral (<i>n</i> = 20) and bilateral orchiectomy (<i>n</i> = 24) groups to assess differential effects.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean age was 59.5 years old. Patients in the unilateral group were significantly younger, taller, and heavier (<i>p</i> &lt; 0.05). Orchiectomy was performed for prostate cancer in 22 patients (50%) and for testicular tumors in 19 patients (43%). No significant differences were observed in QRS width before and after surgery. However, QT and corrected QT (QTc) intervals were significantly prolonged following orchiectomy (QT 383 ± 42 to 403 ± 42 ms, <i>p</i> &lt; 0.01, QTc 416 ± 35 to 433 ± 35 ms, <i>p</i> &lt; 0.001). Post-surgery, there were no significant differences in the QT and QTc interval prolongation between the two groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Orchiectomy was associated with prolongation of QT/QTc intervals, particularly after bilateral orchiectomy. These findings suggest that patients after orchiectomy may be more susceptible to additional factors that prolong ventricular repolarization, including electrolyte abnormalities and QT-prolonging medications. Careful ECG monitoring may be warranted in selected patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 4","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70217","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148350505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond Training Stability: The Need for Clinical Generalizability and Explainability in Self-Supervised ECG Models","authors":"Cem Korucu,&nbsp;Bülent Görenek","doi":"10.1111/anec.70219","DOIUrl":"10.1111/anec.70219","url":null,"abstract":"&lt;p&gt;We read with considerable interest the study by Zeng et al. evaluating self-supervised contrastive pretraining for extreme few-shot electrocardiogram (ECG) classification. The authors should be congratulated for addressing a clinically relevant challenge in cardiovascular artificial intelligence: the scarcity of high-quality annotated ECG datasets.&lt;/p&gt;&lt;p&gt;The study elegantly demonstrates that self-supervised learning (SSL) improves training stability and substantially reduces optimization collapse under severe label constraints. These findings support previous evidence suggesting that representation learning from unlabeled ECG signals can improve downstream performance and label efficiency (Kiyasseh et al. &lt;span&gt;2021&lt;/span&gt;; Sarkar and Etemad &lt;span&gt;2022&lt;/span&gt;).&lt;/p&gt;&lt;p&gt;However, several considerations deserve attention before broad clinical implementation can be envisioned.&lt;/p&gt;&lt;p&gt;First, the proposed framework was developed and validated exclusively using the PTB-XL database. While PTB-XL is among the most widely used ECG datasets, model performance often declines when applied to external populations because of differences in demographics, acquisition hardware, preprocessing pipelines, and disease prevalence. External validation across multicenter datasets remains essential to establish generalizability (Strodthoff et al. &lt;span&gt;2021&lt;/span&gt;).&lt;/p&gt;&lt;p&gt;Second, the study focused on five rhythm categories. Although this design is appropriate for evaluating methodological robustness, real-world ECG interpretation encompasses a broader spectrum of abnormalities, including myocardial ischemia, inherited arrhythmia syndromes, cardiomyopathies, conduction disturbances, and infiltrative diseases. Whether SSL confers similar benefits in these clinically complex settings remains uncertain.&lt;/p&gt;&lt;p&gt;Third, explainability represents a critical prerequisite for trustworthy clinical artificial intelligence. Current regulatory and reporting frameworks emphasize transparency, reproducibility, and interpretability in medical AI systems (Liu et al. &lt;span&gt;2020&lt;/span&gt;; Collins and Moons &lt;span&gt;2019&lt;/span&gt;). While SSL improves optimization stability, clinicians may remain reluctant to adopt models whose decision-making processes cannot be adequately explained.&lt;/p&gt;&lt;p&gt;Finally, the principal benefit observed in the study appears to be enhanced reproducibility rather than a dramatic increase in classification accuracy. Future investigations should determine whether these methodological improvements translate into clinically meaningful gains in diagnostic accuracy, workflow efficiency, and patient outcomes.&lt;/p&gt;&lt;p&gt;Overall, this study represents an important step toward robust ECG-based artificial intelligence. Future work incorporating external validation, explainable AI methodologies, and broader diagnostic tasks may further facilitate clinical translation.&lt;/p&gt;&lt;p&gt;Cem Korucu: Conceptualization, literature review, data interpretation, drafting of the manuscript, and critical revision","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 4","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70219","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148306660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond the Promising Biomarkers: Methodological Considerations in the Use of a Synchronized Heart Sound–ECG System for Pediatric LVSD Detection","authors":"Dengfeng Zhang,&nbsp;Xiaoling Shang","doi":"10.1111/anec.70215","DOIUrl":"10.1111/anec.70215","url":null,"abstract":"&lt;p&gt;We read with great interest the recent article by Gao et al., which introduced a novel synchronized heart sound–electrocardiogram (HS-ECG) system for early detection of left ventricular systolic dysfunction (LVSD) in pediatric populations (Gao et al. &lt;span&gt;2026&lt;/span&gt;). The authors demonstrated that electromechanical activation time (EMAT) and its rate-corrected form (EMATc) serve as age-specific acoustic biomarkers, with EMATc performing better in younger children (3–6 years) and EMAT in older children (7–16 years). While these findings represent a meaningful step forward in noninvasive pediatric cardiac assessment, several methodological considerations warrant further discussion before the approach can be broadly generalized.&lt;/p&gt;&lt;p&gt;First, the interpretation of EMAT and EMATc as diagnostic surrogates for LVSD should be viewed with caution given the absence of invasive or gold-standard hemodynamic validation. Although left ventricular ejection fraction (LVEF) by echocardiography remains the reference standard, it is well recognized that LVEF may not fully reflect subclinical contractile impairment, especially in children with preserved ventricular dimensions or early-stage disease. Previous studies in adult populations have shown that cardiac acoustic biomarkers can be abnormal even when LVEF is preserved (Wang et al. &lt;span&gt;2013&lt;/span&gt;), raising the possibility that the observed correlations may be influenced by unmeasured hemodynamic or loading conditions.&lt;/p&gt;&lt;p&gt;Second, the study's exclusion of children with QRS prolongation, ventricular preexcitation, or paced rhythms, while methodologically sound, limits the applicability of the HS-ECG system in real-world pediatric electrophysiology settings. Sinus node dysfunction, intraventricular conduction delays, and ventricular arrhythmias are not uncommon in children with cardiomyopathy or heart failure, and it is precisely in these patients that noninvasive monitoring tools are most needed. Whether the derived biomarkers retain diagnostic value in the presence of abnormal depolarization remains unknown, as the authors acknowledge.&lt;/p&gt;&lt;p&gt;Third, the choice of heart rate correction—dividing absolute intervals by the RR interval—adopts an adult-derived formula without pediatric validation. Heart rate dynamics in children differ substantially from adults, particularly in younger age groups, where higher baseline rates and greater respiratory sinus arrhythmia may confound rate-corrected indices. Alternative correction methods, such as regression-based normalization or age-specific percentile curves, may have provided more accurate adjustments.&lt;/p&gt;&lt;p&gt;Finally, although the proposed HS-ECG system holds promise for resource-limited settings, the absence of a predefined, prospective management algorithm limits its current clinical utility. It remains unclear what serial change in EMAT or EMATc should prompt echocardiographic referral, medication adjustment, or hospital readmission. Prior work in adult heart f","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 4","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70215","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148275814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Causes of Persistent ST Elevation in Patients With Lung Cancer: A Case Report","authors":"Lijiang Ding,&nbsp;Huayong Jin","doi":"10.1111/anec.70213","DOIUrl":"10.1111/anec.70213","url":null,"abstract":"<p>Cardiac metastases are rare in clinical practice. Herein, we describe the case of a 61-year-old male patient who underwent radical left lung cancer surgery &gt; 2 years before the current admission. The postoperative diagnosis was left lung squamous cell carcinoma (stage pT2N1M0/IIB). Post-surgery, he received adjuvant chemotherapy and did not undergo chest radiotherapy. At the current admission, the patient presented with a dull pain in the left side of his chest. Electrocardiography (ECG) revealed ST-segment elevation; repeat troponin and cardiac enzyme levels were negative. Coronary CT showed 55%–77% stenosis in the proximal-mid left anterior descending artery, but no severe occlusive disease in the other major branches. Cardiac ultrasound revealed a 104 × 49 mm hypoechoic mass at the lateral apex without regional wall motion abnormalities or pericardial effusion. Contrast-enhanced chest CT revealed a metastatic tumor in the left anterior mediastinum with invasion of the pericardium and local left ventricular wall. ST-segment elevation on ECG does not always indicate acute myocardial infarction. In patients with advanced cancer, if unexplained persistent ST elevation without pathological Q waves is observed, the possibility of cardiac metastasis should be considered.</p>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 4","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70213","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148248947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}