Cardiovascular screening in low-income settings using a novel 4-lead smartphone-based electrocardiograph (D-Heart®)

Niccolo' Maurizi, Alessandro Faragli, Jacopo F. Imberti, Nicolò Briante, Mattia Targetti, Katia Baldini, Amadou Alpha Sall, Abibou Cisse, Francesca Gigli Berzolari, Paola Borrelli, Fulvio Avvantaggiato, Stefano Perlini, Niccolo' Marchionni, Franco Cecchi, Gianbattista Parigi, Iacopo Olivotto

Research output: Contribution to journalArticlepeer-review


Background: MHealth technologies are revolutionizing cardiovascular medicine. However, a low-cost, user-friendly smartphone-based electrocardiograph is still lacking. D-Heart® is a portable device that enables the acquisition of the ECG on multiple leads which streams via Bluetooth to any smartphone. Because of the potential impact of this technology in low-income settings, we determined the accuracy of D-Heart® tracings in the stratification of ECG morphological abnormalities, compared with 12-lead ECGs. Methods: Consecutive African patients referred to the Ziguinchor Regional Hospital (Senegal) were enrolled (n = 117; 69 males, age 39. ±. 11. years). D-Heart® recordings (3 peripheral leads plus V5) were obtained immediately followed by 12 lead ECGs and were assessed blindly by 2 independent observers. Global burden of ECG abnormalities was defined by a semi-quantitative score based on the sum of 9 criteria, identifying four classes of increasing severity. Results: D-Heart® and 12-lead ECG tracings were respectively classified as: normal: 72 (61%) vs 69 (59%); mildly abnormal: 42 (36%) vs 45 (38%); moderately abnormal: 3 (3%) vs 3 (3%). None had markedly abnormal tracings. Cohen's weighted kappa (kw) test demonstrated a concordance of 0,952 (p<0,001, agreement 98,72%). Concordance was high as well for the Romhilt-Estes score (kw =0,893; p<0,001 agreement 97,35%). PR and QRS intervals comparison with Bland-Altman method showed good accuracy for D-Heart® measurements (95% limit of agreement ±20ms for PR and ±10ms for QRS). Conclusions: D-Heart® proved effective and accurate stratification of ECG abnormalities comparable to the 12-lead electrocardiographs, thereby opening new perspectives for low-cost community cardiovascular screening programs in low-income settings.

Original languageEnglish
JournalInternational Journal of Cardiology
Publication statusAccepted/In press - Oct 29 2016


  • Low-income settings
  • MHealth
  • Portable electrocardiograph
  • Telemedicine

ASJC Scopus subject areas

  • Medicine(all)
  • Cardiology and Cardiovascular Medicine


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