Ergo Stress - Telemetric cardiovascular analyzer systems for exercise tests

Telemetric cardiovascular analyzer systems for exercise testsTelemetric cardiovascular analyzer systems for exercise tests

  • 3/6/12 channel ECG with complete analysis (measured during exercise)
  • Available both with bicycle-ergometer and treadmill
  • Automatic measurements based on standard or user-configured protocols
  • Programmable, non-invasive blood pressure measuring during exercise
  • Wide range of analysis options: by cycle, averaged, QT, QTv, QTd, HRV
  • Analysis sheets generated automatically by the software (averaged ECG, trends, summarizing sheet, etc.)
  • Immediate report printing using pre-defined printing templates
  • Stress measuring option based on the myoelectric activity of the gastrointestinal tract

 

System

Telemetric cardiovascular analyzing systemsTelemetric cardiovascular analyzing systems
With treadmillWith treadmill
With bicycle-ergometerWith bicycle-ergometer

Telemetric cardiovascular analyzing systems for exercise tests provide stable and reliable follow-up of physiological changes proportional to the exercise done on bicycle ergometer or treadmill.

The systems are working with the high quality devices produced by Ergo-Fit GmbH, system packages including the measuring and exercise devices, and all accessories required for the examination. Thanks to the professional technology of the measuring system and the high quality of the attached exercise devices, artifacts occurring upon movements will influence neither ECG curves nor NIBP values. Furthermore, automatic signal level detection allows stable online monitoring of the heart rate (HR). These conditions contribute to the high accuracy of the evaluation results.

Based on the requirements and possibilities of the user and the examination facility, the measuring devices can be operated either with bicycle or treadmill. The systems are delivered in dual-monitor build-up, together with a custom-made trolley. Due to the telemetric design these systems require no uncomfortable cables, so the measuring setup can be placed anywhere within the examination facility, and need not be placed directly next to the exercise device.

The system provides wide range of application possibilities among others in the everyday practice of cardiologic diagnostics, in sports medicine, and in rehabilitation follow-up.

 

 

 

Patient management and measurement notes

Patient ManagerPatient Manager

The patient manager panel is quickly available via the shortcut icon. Here, data of a new patient can be registered, or previously registered patients can be chosen. The identification code is generated automatically by the software for each patient.

Besides recording of personal data, further documentation (recording weight and height, creating patient groups, export/import of data, recording all information about the patient and the examination), and reloading of the previously saved primary curves can be carried out here. At archiving personal data of the patients, protection of personal data was considered.

Managing measurement notesManaging measurement notes

Besides recording patient data, important details of individual measurements can be recorded and stored into a separate data table.

Measurement protocols

The software contains the standard protocols used in exercise tests (e. g. Cooper, Bruce) which can be immediately loaded and used.

 

Furthermore, we provide opportunity for the user to create new protocols by modifying the existing ones or by programming and applying independent protocols, used and approved before at the examination facility. 

Measurement protocolsMeasurement protocols

In the panel, the user can set the resting phase before measurement (setting the time), exercisephase (setting the speed and angle of inclination, or load wattage) and cooldown after exercise (setting exercise load and time) can be set in the panel.

Moreover, frequency (based on time or load level) of automatic measurements by the included blood pressure measuring device can be set, but the user can start a measurement at any time during the examination, which is equivalent to the programmed ones and the result of which will be also stored.

Protocols created by the user can be saved into the data base of the system and reloaded at any time, for an unlimited number of measurements.

Online ECG monitoring and recording

Online ECG monitoring and recordingOnline ECG monitoring and recording

ECG curves of the patient in up to 12 channels, temperature measured continuously, blood pressure values (measured according to a pre-defined schedule or manually), trend(s) chosen by the user, and the continuously updated superimposed curve, compared to the resting phase, are displayed during the measurement on one or two monitors.

Trends can be displayed one-by-one or in pairs defined by the user:

  • ST Slope (mV/s)
  • P (mV)
  • Q (mV)
  • R (mV)
  • T (mV)
  • ST (mV)
  • RR (ms)
  • HR (bpm)
  • P range (ms)
  • PP (ms)
  • ST segment (ms)
  • ST interval (ms)
  • PR (ms)
  • QRS (ms)
  • QT (ms)
  • QTcb (ms)
  • T-Te (ms)

Offline automatic ECG analysis

After the test, offline analysis sheets included in the software can be completed quickly. For this, previous recording has to be reloaded, then basic conditions (e. g. speed, amplification, trigger level, filters) required for the analysis and optional parameters of the analysis sheets (e. g. which leads should the software use for ECG averaging or which trends should the software calculate and show.) have to be defined.

After the setup, the software evaluates the record and creates the following analysis sheets:

Summarizing analysis sheetSummarizing analysis sheet
Averaged ECG analysis sheetAveraged ECG analysis sheet
Trend analysis sheetTrend analysis sheet
Value analysis sheetValue analysis sheet
  1. Summarizing analysis sheet,
    including the personal data of the patient, all information in relation to the test (e. g. protocol steps, exercise levels, time), and the most important evaluated parameters in tables and graphical representation. The summarizing sheet can be completed with further notes based on the evaluation.

  2. Averaged ECG analysis sheet,
    which is a graphical representation of the ECG cycles lead-by-lead, according to exercise levels, averaged from the ECG recorded during a given exercise level.

  3. Trend analysis sheet,
    which shows the trend(s) of one (or two) parameters for the whole test, lead-by-lead, chosen from the cycles available online (but independently from the displayed ones).

  4. Value analysis sheet,
    which is in close relation with the trend analysis sheet and includes the averaged values of the trends lead-by-lead, according to exercise levels.

 

After the automatic offline analysis, data sheets can be printed out separately or together as pre-defined, clear medical records. For a given examination, offline automatic analyses are freely repeatable, thus can be run again and printed out even with altered parameters (e. g. choosing other trends).

Offline manual ECG analysis

ECG parametersECG parameters

The primary curves saved immediately after examination, or any of the previously archived ones, can be reloaded and re-evaluated. For the evaluation, the program gives six ways which are accessible via the Analysis drop-down menu. During analysis, the system automatically calculates the characteristic parameters from a certain part of the ECG chosen by the user. The calculated parameters are recorded in a table automatically and can be printed out or exported.

Cycle-based ECG analysis with automatic evaluation of the parameters. Cycle-based ECG analysis with automatic evaluation of the parameters
Averaged ECG analysis from cycles selected by the user with automatic evaluation of the parameters. Averaged ECG analysis from cycles selected by the user with automatic evaluation of the parameters

ECG QT evaluation:

  • QT or QTc, depending on RR or HR (user-selected),
  • QT variability (QTv) evaluation from at least 32 cycles.
ECG QT evaluation and QTv (variability) calculation
 QTd (dispersion) determination from 12 leads and one cycle. QTd (dispersion) determination from 12 leads and one cycle
 HRV (heart rate variability) determination by time and frequency range analysis. HRV (heart rate variability) determination by time and frequency range analysis

Gastrointestinal stress measurer option

Gastrointestinal stress optionGastrointestinal stress option

Besides the cardiac (ECG) module,some of the exercise systems (TSE-02 and BSE-02) are available with gastrointestinal stress (EGIG) module as well. Using this supplementary measuring device of the system, myoelectric activity of the gastrointestinal tract can be, besides ECG recording and blood pressure measurement, measured and recorded simultaneously during the exercise test.

Following the examination, records can be evaluated by manual and/or automatic analyses included in the software. This way, the effects evoked by exercise can be further evaluated, using also other aspects besides cardiovascular analyses.

Specification

Telemetry module for ECG

12-channel ECG

50 Hz analogue noise filter, 120 dB

Filtering for motion artifacts (both on treadmill and bicycle)

Bluetooth technology

Transmission distance inside buildings: 10 m

Transmission distance in open areas: 50 m

Battery life (continuous operation without switching off and recharging): 14 hours

Charging time (depending on battery status): max. 4 hours

 

Telemetry module for NIBP

Measurement controlled by software

Measurement frequency defined in protocol: on the basis of time or exercise level

Filtering for motion artifacts (both on treadmill and bicycle)

Systolic pressure measurement range: 25 – 280 mm Hg

Diastolic pressure measurement range: 10 – 220 mm Hg

Bluetooth technology

Transmission distance inside buildings: 10 m

Transmission distance in open areas: 50 m

Battery life (continuous operation without switching off and recharging): 14 hours

Charging time (depending on battery status): max. 4 hours

 

EGIG stress holter module

Four-channel recording

Battery life (continuous operation without recharging): 24 hours

Configuration controlled from computer software

Memory capacity: 4 GB (approx. 1,450 hours of measurement data)

Manual starting with automatic shut-down protection

 

Treadmill

Controlled by computer software

Gradient adjustable between -5% and +15% or 0% and 20% (depending on type) in increments of 10,5%

Speed adjustable between 0 km/h and 25 km/h, in increments of 0,1 km/h

 

Bicycle ergometer

Controlled by computer software

Load adjustable between 15 W and 600 W, in increments of 5 W

How can it help?

Our exercise test systems are outstanding examples of product development based on Hungarian innovation and reliable German production technology. Compared to other systems used routinely in this field, the advantage of systems is that they preserved the proven and widely used cardiac examination modes (e.g. ST analysis, continuous monitoring and trend indication of HR, RR and NIBP), further that online (during exercise) and offline (after exercise) analysis of cardiovascular changes occurring upon exercise can be done more profoundly. A further remarkable benefit is that, based on gastrointestinal motility changes (EGIG), stress effects can be examined independently from the cardiovascular system during the whole examination period. The Holter module (EGIG-02), which records the myoelectric signals continuously, can be freely connected to any of the systems.

The abilities of the analysis surface of the system shall be demonstrated here with the preventive diagnosis of risk factors of "sudden cardiac death". In its background, risks from hardly recognizable silent ischemias and myocardial infarctions are often present. In younger individuals, "sudden cardiac death" is often caused by hereditary diseases resulting in arrhythmias, such as the congenital long QT syndrome (LQTS) leading to disorders in the repolarization of heart muscle[1]. Phenotype is highly variable in patients with LQTS, and the individual susceptibility to arrhythmias can be completely different also in patients having the same LQT mutation[2]. In patients carrying subclinical LQT mutation and having normal length of QT interval measured by conventional ECG technique, life-threatening arrhythmias or "sudden cardiac death” can occur due to drugs or dietary factors which prolong cardiac repolarization[3]. Currently it is a major problem in the clinical practice to estimate the risk of and predict the incidence of life-threatening arrhythmias [4].

The concept of the repolarization reserve was formed in relation to the above mentioned problems[5-6] and its predictive value has been proven experimentally[7-8]. According to this concept, if the repolarizing function of one ionic current in the heart muscle decreases due to congenital or acquired causes, it willnot necessarilyresult inclinicallyobservableprolongationof repolarizationand in arrhythmia (merely in decreased repolarization reserve), since the other ionic currents are able to compensate for the missing function. However, if repolarization is further is inhibited (even mildly, e.g. by non-cardiovascular drugs or by dietary factors), significant prolongation of the QT interval and severe ventricular arrhythmias can occur, which can cause "sudden cardiac death”.

In the recent years, the use of a new ECG parameter has been proposed as a more reliable predictor of proarrhythmic risk and for the investigation of repolarization reserve. This is the beat-to-beat measurement of QT interval variability, characterizing the instability of cardiac repolarization, which can numerically define short-term variability of the QT interval[9]. The increment of short-term variability was better correlated with the incidence of serious ventricular arrhythmias occurring later than the conventional ECG parameters, both under preclinical[10-11] and clinical circumstances [12-14].

The above mentioned changes can occur at an increased level upon exercise, so these analysis functions became included as well. At the end of the examination, the system provides automatic evaluation of all parameters (time, amplitude) of the ECG, which can be printed out together with the screenshot. Furthermore, the saved primary curves can be reloaded, and analyzed in details depending on exercise, at any time.

The exercise test systems used for cardiac diagnostic examinations (in general cardiology, sports medicine, military training, etc.) do typically focus first of all on the electrophysiological examination of the heart. In case of athletes, this is complemented also with a limited CO2 measurement. In professional circles, the demand on a non-invasive method, where the examined person is not limited in movements, and where simultaneously with the measured parameters of heart function stress effects can be also detected, has been raised several times. It is a well-known physiological paradigm that effects of stress can be observed through the motility disorders of the gastrointestinal tract (stomach and bowels). The enteric nervous system constitutes a separate unit, to be considered as a “visceral brain”, the functioning of which is, however, not really autonomous. Sympathetic and to a lesser extent parasympathetic, vegetative efferents interlace the enteric nervous system and work as primary signalling system in the rapid evaluation of external stress effects.

The objectivity of the examinations could be significantly increased by the exact registration of those facts that in what extent can cardiovascular disturbances occurring upon exercise be traced back to the pathological changes of this region or to the indirect effect caused by exercise induced stress.

References:

  1. Roden DM. Clinical practice. Long-QT syndrome. N Engl J Med 2008, 358: 169-176.
  2. Benhorin J et al. Variable expression of long QT syndrome among gene carriers from families with five different HERG mutations. Ann Noninvasive Electrocardiol 2002, 7: 40-46.
  3. Schwartz PJ et al. Genotype-phenotype correlation in the long-QT syndrome: gene-specific triggers for life-threatening arrhythmias. Circulation. 2001, 103(1): 89-95.
  4. Odening KE, Brunner M. Risk stratification in long QT syndrome: Are we finally getting closer to a mutation-specific assessment of an individual patient's arrhythmogenic risk? Heart Rhythm 2013, 10: 726-727.
  5. Roden DM. Taking the idio out of idiosyncratic-predicting torsades de pointes. Pacing ClinElectrophysiol 1998, 21: 1029–1034.
  6. Varró A, Baczkó I. Cardiac ventricular repolarization reserve: a principle for understanding drug-related proarrhythmic risk. Br J Pharmacol 2011, 164(1): 14-36.
  7. Varró A et al. The role of IKs in dog ventricular muscle and Purkinje fibre repolarization. J Physiol 2000, 523: 67–81.
  8. Jost N et al. Restricting excessive cardiac action potential and QT prolongation: a vital role for IKs in human ventricular muscle. Circulation 2005, 112: 1392–1399.
  9. Varkevisser R et al. Beat-to-beat variability of repolarization as a new biomarker for proarrhythmia in vivo.HeartRhythm 2012, 9: 1718 –1726.
  10. Lengyel Cs et al. Combined pharmacological block of IKr and IKs increases short-term QT interval variability and provokes Torsades de Pointes. Br J Pharmacol 2007, 151: 941–951.
  11. Thomsen MB et al. Increased short-term variability of repolarization predicts d-sotalol-induced torsades de pointes in dogs. Circulation 2004, 110: 2453–2459.
  12. Hinterseer M et al. Relation of increased short-term variability of QT interval to congenital long-QT syndrome.Am J Cardiol 2009, 103: 1244–1248.
  13. Hinterseer M et al. Usefulness of short-term variability of QT intervals as a predictor for electrical remodeling and proarrhythmia in patients with nonischemic heart failure.Am J Cardiol 2010, 106: 216–220.
  14. Lengyel Cs et al. Increased short-term variability of the QT interval in professional soccer players: possible implications for arrhythmia prediction. PLoS ONE. 2011, 6(4): e18751.

Available models

You find details by clicking on the product code.

TSE-01 Telemetric analyzer system for exercise tests on treadmill with ECG module

Under construction

BSE-01 Telemetric analyzer system for exercise tests on bicycle-ergometer with ECG module

Under construction

TSE-02 Telemetric analyzer system for exercise tests on treadmill with ECG and EGIG modules

Under construction

BSE-02 Telemetric analyzer system for exercise tests on bicycle-ergometer with ECG and EGIG modules

Under construction

Media

Telemetric cardiovascular and stress analyzer systems for exercise tests  Download the catalogue in pdf version!

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