• FOURIER POvffiR SPECTRUM ANALYSES OF ELECTROCARDIOGR~M TRACES by Martha Melinda Brown Honors Paper Ball State University May 1976 Adviser: Dr. David Ober TABLE OF CONTENTS i Lis1: of Tables and Figures :r. II. III. INTRODUCTION. • • • • 1 THE ELECTROCARDIOGRA11 2 A. Electrical Activity of the Heart • 2 B. The Standard Electrocardiogram • 8 C. ST Depression 8 ANALYSIS • • • • • • · 11 A. Fourier Analysis • . B. Criteria for the Diagnosis of Depression . • • • . 11 < C. IV. V. S~ • • • • • • • • • • Patient Data RESULTS . 13 • • 13 15 A. Lead I Analyses • • 15 B. Twelve Lead Analyses • • • 18 CONCLUSION . • 20 REE'ERENCES 21 APPENDIX A • 22 APPENDIX B . • • 34 LIST OF TABLES AND FIGURES FiH. 1. Distribution of the body fluids in tissue with concentrations of the major cations in the extracellular and intracellular compartments. ·······. · 3 ··· 5 Fig. 3. Electrical conduction system of the heart •• 6 Fig. 4. Sequential electrical events of the cardiac cycle. 7 Power spectrum determination of a truncated triangular wave •• 12 Fi~J • 2. Fig. 5. · · Activation of the excitable cell. .. . . . . · · · · · · · . · ·· · · · · · · · . . . · · · Table I. Normal limits of S-T Segments . . . • . Table II. Results of the Fourier power spectrum analyses for lead I data. . • • • . • Table III. Averages and standard deviations for leads one through twelve. . • • . . • . • . • . . I i 9 16 19 I. INTRODUCTION The electrocardiogram is a valuable tool in diagnosing heart abnormalities. Cardiologists have mainly used visual methods for the clinical analyses of electrocardioqrams (EKGs). utilizE~d Hore recently, computers have been to perform these analyses. In this investigation EKGs were analyzed utilizing a computer. Specifically, Fourier analyses were performed on various EKGs. In an earlier study at Ball State Uni- versity, Larry McCutchan investigated a similar problem by using Fourier analysis on lead I electrocardiograms for patients with ST depression. His results indicated that certain harmonics can be associated \"i th a depressed ST segment. The present study utilized the HcCutchan criteri.a for investigating more lead I data and for investigating all twelve leads for selected normal and ST depression patients. For more information concerning the utilization of Fourier analyses and computer programming in the diagnosis of heart abnormalities, refer to the study by Larry McCutchan. 1 -- II. THE ELECTROCARDIOGRAM A. Electrical Activity of the Heart The heart is a muscle which pumps blood. Electrical activity triggers coordinated contractions of different parts of the heart. The electrical activity is controlled by the impulses received in the cells of the muscle. Many times the impulses are broken causing electrical abnormali tiE~s called cardiac arrythmias. Living cells in the body are controlled by three parts; intracellular fluid, extracellular fluid, and the cell membrane. The extracellular fluid is composed of various gases, electrolytes, metabolites, and water. cell mE~mbrane The constantly expends energy as it pumps differ- ent electrolytes into and out of the cell. The electro~ lytes distribute themselves inside and outside the cell membrane such that negatively charged ions collect on the inside surface of the cell ':membrane and positively charged ions collect on the outer surface. This produces a potential of about -85 millivolts (see Fig. 1). When this potential reaches a maximum charged state it is termed a resting cell. I ,- The cell is waiting for a stimulus which will neutralize the membrane. This process, called depolarization, causes the ions on the inner and outer 3 THE -1_ _ _ BODY UIDS EXTRACELLULAR 1 --------+---- INTERSTITIAL • & I ~ • J.... "' .. .#" J ~ .., J 1 ~ .... .... ...... . " .J .. , .' I "I \ \ 'II" .. " .... " \~ .. " , .. , 11 .. : \1 ... ". . '\~ , • .: .. , , ' .. \. ..... !' .. ", " ,., . """"T, _" '" •,.,\..... ~J....L.1J ..... ," ; ....•... \ ,. .. ~ '" ,, .. ~ ~ \. , .. \ .: ............ '"' '.') I 4 ~ • CONN"~CTIVE TISSUE sonIUr-r POTASSIUM Na+ K+ 140 4 - CALCIUK ea++ 5 I>1AGNESIUM Mg++ 2"- Fig. 1. 10 150 1 40 Distribution of the body fluids in tissue, with concentrations of the major cations in the extracellular and intracellular compartments. figure was taken from Ref. 2. - This 4 membrane surface to change positions. This disturbance of the :resting cell.is called an impulse. Some cells do not need any stimulation and depolarize automatically. This impulse producer is known as automaticity and in the heart is called the pacemaker. Once depolarization begins it spreads from cell to cell. Following depolariza- tion the cells begin to return to the resting state by the process of repolarization (see Fig. 2). ']~he betwee~ pacemaker of the heart lies in the right atrium the superior and inferior vena cava (see Fig. 3). This group of cells is known as the sinus node. Impulses begin here and travel through the heart in a depolariza-tion effect. Since the impulse of the sinus node is weak, the first measurable impulse is the depolarization of the atrial muscle. In the electrocardiogram this is labeled the P wave (see Fig. 4). The impulse spreads from the atria to the ventricles by means of the A-V node. These impulses are not strong enough to be recorded by the electrocardiograph and thus are represented by the flat segment following the P wave. The impulse travels to the common bundle and splits into the right and left bundle branches. The impulse ·then moves from inside the ventricles to the outside. The depolarization of the right and left ventricles is recorded as the QRS complex. The next segment is the ST segment representing a period of electrical inactivity. I - Repolarization of the ventricles is recorded as the T wave. The T wa're is sometimes followed by a U wave which is the 5 STIMULATION ...;.------- ~1AXIMUM - -- NULL Fig. 2. Activation of the excitable cell. This figure was taken from Ref. 2. ) ) AORTA SUPERIOR VENA CAVA AURIClE OF RIGHT ATRIUM PULMONARY VEoo J AURICLE OF LEFT ATRIUM S .• A. NODE LEFT ATRIUM (BACK OF HEART) CORONARY SINUS LEFT BUNDLE BRANCH i A.V. NODE LEFT VENTRICLE BUNDLE OF HIS RIGHT BUNDLE BRANCH RIGHT ATRMT PURKINJE FIBERS INFERIOR VENA CAVA Fig. 3. RIGHT VENTRICLE Electrical conduction system of the heart. was taken from Ref. 3. This figure '" 7 R T. 1 SEQUENTIAL EIECTRICAL EVEN'IS OF THE CARDIAC CYCLE ELECTROCA?DICGRAPHIC REPlBSSNTATICN 10 Impulse from the sinus node not visible 2. Depolarization of the atria P wave :3. Depolarization of the A-V node 4. Repol~rlzation of the atria 5. Depolarization of the ventricles ao b. intraventricular septum right and left ventricles 6. Activated state of the ventricles IsoelectriC' Usually ob3cured by the Q,RS complex QRS complex a. initial portion bo central and terminal portions St segment. isoelectric immediately after depolarization 7. Repolarization of the ventricles 8. T wave After-potentials following repolarization of the ventricles Fig. 4. cardiac cycle. U wave Sequential electrical events of the This figure was taken from Ref. 2. 8 sum of many repolarization events. The electrocardiograph records a flat signal on the baseline until the next beat evolves. 2 B. The Standard Electrocardiogram By placing electrodes at different points on the body, electrocardiogram data for several leads can be compared. Different placements detect the same type of information, but from different positions. A standard electrocardiogram utilizes twelve leads; six limb leads (three bipolar and three unipolar) and six chest leads. The difference in the ST segment for each lead can be shown by comparing their normal limits of displacement from the baseline. These are shown in Table I. c. ST Depression ST depression is a cornmon heart abnormality appearing in electrocardiograms. utilizing a stress test. It often discovered by Michael Ritota in Diagnostic Electrocardiography defines ST depression as a ST segment depression of one rom or more from the baseline. 3 ST depression may be associated with many abnormalities including ischemia, digitalis effects, right ventricular hypertrophy, and complete bundle branch block, The seg- 9 TABLE I. NOrn-~AL LD!ITS OF S-T SEc;r.~NTS (This table was taken from Ref. 3.) - I LEAD S-T DISPLACEI:ENT I +1 to -1 mm. II +1 to -1 mm. III +1 to -1 mm. aVR +1 to -1 mm. aVL +1 to -1 mm. aVF +1 to -1 mm. V1 ' V2 +2 to +4 TTun. to -1 TT'm. V , V4 ' V ' V6 3 S +2 to +4 mm. to -1 mm. 10 ment can be a horizontal, sagging, or angular depression • - . - III. ANALYSIS A. Fourier Analysis A function which periodically repeats itself, such as the electrocardiogram, can be represented by a Fourier series. The Fourier series for the function f(x), over the interval (O,L), is given by the following rela.tion: 4 ~ f (x) = Ao/2 +y\~/0ncos (21inx/L) + Bnsin (Cfinx/LU (1) where L An = 2/LJ f(x)cos(CfInx/L)dx (2) o and Bn = 2/L ro l f(x)sin(2finx/L)dx (3) and n is the number of the harmonic. The coefficients, An and Bn' can be combined to form the power spectrum coefficient, c n ' lV'hich is given by (4) When c n ' is plotted as a function of the frequency, a power spectrum is obtained. Shown in Figure 5 is the power spectrum for a truncated triangular wave. Since this function is an even function, there are no sine terms and therefore, no Bn tE~rms. 12 r(x) O. -Y2 <x <-L/3 -t/3<x < - 1 x, o <'x < 1/3 L/3 <x < L/2 L -it -1 2 o. +lL +1-. 3 2L t 3 0 A truncated triangle wave . 10-1 .. 10- 2 n • 0 1 2 • 10-3 3 •• 4 .5 10-4 6 7 10-5 . o 'I 1 t 234 I .5 , t 6 7 Power spectrum for a truncated wave Fig. 5. Power spectrum determination of a trun(:ated triangular wave. Refer to reference 4. cn0 .104 .007 .002 .0004 .0002 0 .00004 13 The computer program used in this investigation to compute power spectra was developed in an earlier study at Ball state University by McCutchan. A listing of t:he program and additional programming details are givem in Ref. 1. B. Criteria for the Diagnosis of ST DepresSion Two criteria were developed for the diagnosis of ST depression in an earlier study at Ball State University performed by J'.lcCutchan. l The first crlterion to suggest ST depression was that the second power spectrum coefficient (third harmonic), c2' be greater than. nine per cent of the total power, Pt. of all of the power spectrum coefficients. P is the sum t The second criterion was that the ST score be less than three where J...o STscore = «(Pt) ~ c n ) / (lOOOc2) • n= 13 C; Patient Data Digitized electrocardiogram data for 74 patients were obtained from the Public Health Service's Ecan-E program. A patient was defined as having ST depression if two of the three ST segment voltage readings were negative. - Of these 74 patients, 14 were considered as having a depressed ST segment, 17 were (5) 14 normal, and 43 had other abnormalities. Lead I data were analyzed for all 74 patients. All twelve lead EKGs for 13 normal patients, 10 ST depressed patients, and 3 with other abnormalities were also investigated. Refer to Appendix A for the power spectrum plots of twelve leads for a ST patient. Details concerning the digitizing rate and stretching of the data for Fourier analysis has been given in the previous study carried out by McCutchan. l IV. RESULTS In the study conducted by McCutchan l , lead I EKGs were investigated for 14 patients whose EKGs were identified as normal and for 10 patients whose EKGs were diagnosed as having ST depression. Through these analyses the t:wo criteria were developed (see Sec. III. B) to identify ST depression. These criteria were utilized throughout the analyses of this investigation. A. Lead I Analyses The lead I EKGs were analyzed for 74 patients whose EKG data were obtained from the Public Health Service (see Sec. III. C). Fourteen of these patients were classified as having ST depression, 17 were classified as normal, and the remaining 43 were classified as having various abnormalities. (These classifications resulted from Ecan-E computer analyses of the l2-lead EKG analysis.) Presented in Table II are the results of the Fourier power spectrum analyses. It is seen that 21% of the 43 "abnormals" - satisfied both of the ST criteria, 16% satisfied one of the criteria, and the remaining 63% were found to 16 - Table II. Results of the Fourier power spectrum ana.1yses for lead I data. Pat.ient Number Per cent c 2 ST score Both One None Abnormal Patients 2 3 4 6 7 8 9 11 14 15 16 17 21 22 23 26 29 30 31 32 33 35 36 38 40 45 47 48 49 51 53 54 57 58 I - .59 62 63 '70 '71 73 }4 41.1 12.4 1.2 2.7 18.5 6.9 5.9 3.2 1.8 15.1 2.5 7.2 12.1 4.6 8.7 12.6 .3 8.0 2.8 12.4 11.4 15.1 3.2 9.3 2.2 1.3 4.1 9.9 2.8 .5 4.9 6.1 4.2 1.2 .3 4.9 16.4 4.3 8.2 3.0 11.4 .1 1.4 22.3 11.3 1.6 7.3 9.0 8.0 21.6 1.2 18.7 3.1 5.3 4.5 2.1 4.4 120.6 3.4 7.3 5.0 .9 1.2 12.4 4.6 15.8 20.9 9.5 3.3 9.3 71.2 2.9 3.9 9.1 26.7 95.6 3.8 .5 12.4 5.4 9.2 1.2 * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * 17 - Table II. cont. Pa't:ient Number 76 79 Per cent c2 ST score 14.6 5.7 .9 4.2 Both One * None * ST Depression Patients 1 19 25 28 37 39 41 42 55 64 67 69 72 77 22.6 10.0 9.5 15.5 16.6 12.6 13.4 11.7 8.0 10.4 25.2 6.0 14.9 2.9 .7 1.4 2.9 .9 3.1 1.4 .8 1.3 3.2 2.1 .2 4.7 1.4 11.4 * * * * * * * * * * * * * * Normal Patients 5 10 12 13 18 20 24 27 43 44 46 50 52 56 60 65 78 2.1 11.5 1.4 8.3 3.1 8.3 5.1 1.5 8.4 3.2 6.6 6.4 3.8 16.2 4.1 1.7 6.9 16.5 5.0 29.6 2.9 12.2 4.0 5.6 18.9 2.4 15.2 7.3 3.5 10.1 1.3 7.5 14.4 4.0 * * * * * * * * * * * * * * * * * 18 satisfy neither of the ST criteria. Of the 14 "ST" patients, ten, one and three of the patients satisfied both, one, and none of the criteria, respectively. Of the 17 "normal" patients, one, three, and thirteen of the patients satisfied both, one, and none of the criteria, respectively. B. Twelve Lead Analyses For 24 patients (13 normal and 11 ST depression) , all 12 EKG leads were Fourier analyzed to determine if the two criteria developed to identify ST depression in lead I EKGs might also be valid for other EKG leads. Presented in Table III are averages and standard deviations for leads one through twelve for the (a) c 2 per cent and (b) ST score criteria for both the "normal" and "ST\! patients. Presented in Appendix B are the raw data from which these results were derived. Leads 1, 11, and 12 show significant differences bet\'{een the criteria averages for the normal and ST patients in that the standard deviations for the averages do not overlap. a dE~finite Leads two through six and ten show difference between the normal and ST patient averages, however, these averages with the associated standard deviations do overlap. Very little difference is c)bserved between the normal and ST patient averages for either criterion when using leads seven, eight, and nine. ) ) PER CENT CRITERION LEAD NORMAL PATIENT ST SCORE CRITERION ST PATIENT NORMAL PATIENT ST PATIENT 1 r= 1'\ + ..J.v .,. ~.':1 14.1 ± 5.1 9.6 ± 5.0 1.5 ± 1.0 2 6.4 ± 3.5 10.3 ± 4.5 6.7 ± 4.5 4.5 ± 4.7 9.9 ± 5.8 5.8 ± 8.4 5.2 + - 5.6 ± 4.8 4.3 + - 7.5 ± 3:·2 3. ,., n 16.1 + - 11.5 4 4.4 ± 2.0 10.8 ± 4.1 8.9 5 6.7 + - 4.8 13.7 + - 6.7 10.9 6 12.1 + - 9.3 9.1 + - 6.6 5.3 - 7~1 7 12.4:!: 4/2 8.5 2.2 + - 1.8 1.0 + - .6 8 18.2 + - 7.0 16.7 + 17.1 + - 6.8 ·.2.3 ± 2.2 2.5 + - 3.1 9 11.5 + - 7.6 11. 5 + - 9.1 11.5 + - 7.8 9.6 - 12.0 ± 11.6 + 2.8 12.9 + - 22.4 '" 10 4.3 + - 3.7 11. 2 + - 6.8 11 3.1 + - 46.0 ""- 64.0 2.0 11. 8 f 5.4 22.6 + - 27.4 + 5.0 2.4 + - 12 2.8 + - 1.8 12.1 + - 5.9 17.1 + - 13.4 2.3 + - (·2.0 Table III. 5.1 1.7 Averages and standard deviations for leads one through twelve I-' \0 v. CONCLUSION A"primary purpose of this investigation was to detE~rmine whether the Fourier analysis of digitized EKG data could be used to identify EKG abnormalities. From the results of this study, there does appear to be a correlation between power spectrum coefficients and certain heart abnormalities such as ST depression. The criteria used in this study for the diagnosis of ST depression were affective with certain leads (namely one, eleven, - and twelve), however, several other leads (such as seven, eight, and nine) showed no difference between normal and ST patients. In these cases additional studies may show that different criteria for the diagnosis of ST depression needs to be established which would utilize other harmonics and/or combinations of harmonics • - . 21 - - . REFERENCES 1: Larry J. McCutchan, Identification of Abnormal ST Segments in Electrocardiograms Using Fast Fourier Transform Analysis, M.S. Thesis, Ball State University, November (1975). 2. R. E. Phillips and M._ K. Feeney, The Cardiac Rythms (W. B. Saunders Co., Philadelphia, PA, 1973). 3. M. C. Ritota, Diagnostic Electrocardiography (J. B. Lippincott Co., Philadelphia, PA, 1969). 4. F. R. Merrill, Using Computers in Physics (Houghton Mifflin Co., Boston, 1976) • 22 APPENDIX A P\ 1.0 ~- L \ '- ~ ~ ~ ir'"""' ""--- "'"'" ~ - -1.0 100 10 (\J w 0 ::J r-- ~ i\ 1 I , --1 CL I ::t:: IT. I O. 1 0.01 0.001 10Fa SOFa PClWER SPECTRUM 120FO 23 1.0 , w o ::J 0 r-.I 0... V V " :c a: . V "'"'- / r----- ---- / /' ~ '- ~ ...,....,. N-- - - -1.0 1000 100 ~I~ ~ 10 N W 0 ::J r- 1 I -.J a... :i: a: I O. 1 \~ I ~ I ~ lVvl 0.01 I I I ! I I ~~ () 0.001 \ lOFa 60Fa PClWER SPECTRUM \ 1\ 1\ I~ 120f1J 24 - 1.0 lJ...J o ~ 0 ~, I~ ::l -1 CL :s::: a: . \ ~ ~ ~ -1.0 V I--' N 1000 -- 100 10 Iv ~ I \w- I I I I N I lJ...J 0 ::l ~ ....... I -.J (L , I :L a: ~~~ O. 1 I I ( ~ ~~ A1//\ , 0.01 , \ -- 0.001 10Fo 60 Fi0 ! I 'IV A ~. l) PClWEA SPECTRUM ! ~. fV\ ~fl ~ N1V 12( FU V 25 -. P I l..1...\ 1.0 - w - - o :::l '- :: 0 ~ -' CL :s::: ~ ~~ ~ ~V /"" '\ (\ r ' ~ - a: Iv -1.0 1000 I~, 100 [\ ~ I I I 10 I N r W 0 I :::l r- ......... I 1 -' CL II ~ :s::: a: - I, I I I ,I I ! I I ,! i i i I I I I. I ,I I r I i i i I ! I I I I, ,I I ,I I O. 1 I I Ir I - i i .~~ 0.01 -- 0.001 N lOFo ~ ~ 60Fo 1J1 I ~ PClWER SPECTRUM t )) I ~i ~~ I ::r 120FO 26 1.0 ~ - r---.- ~ ~ ..- II .-,. f"-- '- ~ l- -1.0 I- 1000 100 10 ~l, I I 1\ I I i C\I \ I..Ll 0 :::l l- I -..J (L :s:: a: f\ I \11 O. 1 0.01 0.001 lOFa \ I Ii I I I I I I II I I I II II r 1\ f\1~ SOFa II ! I I I I I !i I I I I I I II J1' \ ~t ~ PClWER SPECTRUM II ~: ~ , ~\ j !~ ~ 120fu / 27 - 1.0 w o :::l r- 0 ~, ~ -1 (L. ~ a: ~ I,-r-" ~ ~ ~ -'""" V - - ~ I- -1.0 ./\ I- - - 1000 I I - 100 niJfr 10 I C\I W 0 :::l l- I I I I I -1 I (1... s:: I IT. V~! O. 1 I I !'vi I I I I " VI ~IJ II N 0.01 - 0.001 10Fo I 60Fo PClWEA SPECTRUM I I J I - I I ! iI I I I I ~ I ~ ~ ~U rf 120fo lr 28 - 1.0 w o ::J 0 r-l CL. s:: cr: . -1.0 1000 - v - " l- I I I Ir 100' ~ ~ I II I 10 N W 0 :::J r- --< 1 1 -l CL I s:: IT: O. 1 0.01 - 0.001 i OFo 60Fo P~WEA SPECTRUM 120ft, 29 - 1.0 t- -1.0 I - r---... I I I I I ...; I I i I 10 l I N w 0 ::J l- I -.J 0.. ~ IT O. 1 0.01 o. 0 0 1 '----1O+-Fi-o-+--+-----Ir-----t 60Fa PClWER SPECTRUM 120fll 30 -1 .0 I - I I ., - r- V -- -- ~ ""'--- 1 -1. Or- - ! 1000 100 l I J 10 N w I 0 =:J r- 1 I I .-J CL :c a:: I I O. 1 0.001 I I II I I 0.01 I I - 1 CiFo SOFo P~WEA SPECTRUM I I! 31 - 1.0 ) w o ::) .~ ~ 0 .....J (L. :::E a: . - t-- .,..~ - -1.0 - I 1000 ft' 100 I I I I I 10 (\J w I I I I II 0 ::) t>-1 i --1 I I 0.. :i: I IT. I I I I O. 1 I I 1\ \ n 0.01 - 0.001 10Fo ~ ~ ~ VvAIjlll J V 60Fo PllWEA SPECTRUM lA 120Fo II 32 ..- r'\ 1.0 w o :::J I- 0 -.J CL :i: 0:. -1.0 ~v - ,I I ",,- I...I .........-- v r r r 1000 100 10 ~~ - ~ - I C\J W 0 :::J l- I - -.J CL. :i: IT. I O. 1 /: ~01 0.01 0.001 lOFo (\ hJ\ 60Fo Pl:lWEA IL. SPECTRUM I .~ ~ A 1\ 120Fo 33 1 .0 ~ .--r- ~ ~ r- - -1.0 r- - r- 1000 ~ 100 - ! I 10 N - I W 0 ::J t- I -1 I ........ u.. ,i J I I I s:: a: I I I I I O. 1 ~I~ 0.01 0.001 - I , I I I I i - h - If l)Fo ~ SOFe P~WEA ~ N ~ bA Jl\ ~f\f 11 SPECTRUM ~ 120FU 34 APPENDIX B Table III. Results of the Fourier power spectrum analyses for leads one through twelve. Pat:ient Number °2 Per cent ST score Both One None Normal Patients Lead 1 .- 10 18 27 5 46 50 60 13 20 43 44 52 65 11.5 3.2 1.5 2.1 6.6 6.4 4.1 8.3 4.2 8.4 3.2 3.8 1.7 5.0 12.2 18.9 16.5 7.3 3.5 7.5 2.9 8.5 2.4 15.2 10.1 14.4 * * * * * * * * * * * * * Lead 2 10 18 27 5 46 50 60 13 20 43 44 52 65 3.0 .2 10.6 1.1 5.8 7.4 16.9 6.4 4.5 1.3 7.9 7.4 4.0 5.7 146.9 2.8 20.0 6.1 4.7 2.5 3.8 4.6 13.5 6.4 3.4 7.0 * * * * * * * * * * * * * 35 -.-" . Table III cont • Lead 3 10 18 27 5. 46 50 60 13 20 43 44 52 65 20.8 1.6 31.0 2.4 3.1 25.4 21.9 32.6 4.2 11.5 9.9 11.3 33.2 1.3 19.5 3.6 28.9 9.8 1.3 .5 .6 3.6 •8 3.81.5 .6 * * * * * * * * * * * * * Lead 4 10 18 27 5 46 50 60 13 20 43 44 52 65 2.8 1.8 5.7 4.1 3.5 2.9 7.2 6.1 4.1 6.4 7.3 4.4 1.4 13.4 16.5 5.6 6.8 12.5 9.8 5.2 3.5 5.7 3.9 7.2 7.2 18.9 * * * * * * * * * * * * * Lead 5 .- 10 18 27 5 46 50 60 13 20 43 44 52 65 17.8 9.0 11.Q .9 1.1 7.6 5.0 12.1 8.6 3.9 3.7 1.6 4.6 5.1 7.3 3.0 40.3 28.7 3.1 5.6 2.0 1.1 5.3 14.7 21.0 5.0 * * * * * * * * * * * * * 36 ,- Table III cont. Lead 6 10 18. 2'2. 5 46 50 60 13 20 43 4~ 52 65 10.9 1.0 12.1 10.7 3.2 19.2 37.0 6.1 4.5 21.7 ·13 .. 0 6.2 11.4 .7 27.8 3.2 1.6 12.0 3.4 .9 3.6 4.2 1.7 3.0 4.1 3.0 * * * * * * * * * * * * * Lead 7 10 18 27 5 46 50 60 13 20 43 44 52 65. ~ 19.8 8.0 11.9 16.4 11.0 11.4 13.3 10.6 15.1 17.6 3.8 7.9 14.4 .5 1.9 2.3 1.2 2.7 1.8 1.6 1.7 2.0 10.4 7.2 4.3 1.4 * * * * * * * * * * * * * Lead 8 10 18 27 5 46 50 60 13 20 43 44 52 65 (- 25.5 16.1 5.8 19.7 21.9 22.6 20.5 19.1 17.1 11.4 12.2 11.6 33.5 .9 .9 9.2 1.2 1.0 .8 .9 1.3 2.4 4.2 3.1 3.0 .5 * * * * * * * * * * * * * 37 -. Table III. cont. Lead 9 10 18 27 5 46 50 60 13 20 43 44 52 65 19.7 23.9 2.4 1.9 22.4 10.9 15.0 19.9 3.7 7.2 10.1 7.4 5.3 2.1 .7 14.0 29.9 1.5 6.3 2.7 1.9 15.2 6.5 5.1 9.0 6.8 * * * * * * * * * * * * * Lead 10 10 18 27 5 46 50 60 13 20 43 44 .52 65 6.4 .3 3.3 1.1 11.7 6.1 7.5 7.3 .3 8.6 1.9 1.6 .1 11.8 106.2 8.4 32.5 5.5 8.0 8.3 7.9 134.4 3.2 27.8 23.0 220.7 * * * * * * * * * * -#: '* * Lead 11 10 18 27 5 46 50 60 13 20 43 44 52 65 .4 .9 3.7 2.2 2.9 6.1 4.0 6.7 1.8 4.6 2.0 4.5 .8 110.9 32.3 7.3 13.9 15.3 6.1 8.9 5.5 21.1 4.7 24.8 6.9 36.3 * * * * * * * * * * * * * 38 .-. Table III. cont • Lead 12 10 18 27 5 46 50 60 13 20 43 44 52. 65 .9 1.7 1.4 2.5 .7 7.0 4.4 2.3 1.3 3.5 1.8 5.6 2.6 31.8 17.4 18.1 10.2 53.9 4.6 6.2 12.1 20.9 5.3 25.5 5.5 10.7 * * * * * * * * * * * * * ST Patients Lead 1 25 28 1 39 19 41 42 64 67 72 79 9.5 15.5 22.6 12.6 10.0 13.4 11.7 10.4 25.2 14.9 9.7 25 28 1 39 19 41 ·42 64 67 72 '79 6.2 7.3 7.8 14.0 18.1 2.6 8.8 8.6 14.0 10.3 16.0 2.9 .9 .7 1.4 1.4 .8 1.3 2.1 .2 1.4 3.5 Lead 2 7.5 1.9 14.8 .6 .7 12.6 1.6 2.2 1.2 2.6 3.2 * * * * * * * * * * * * * * * * * * * * * * 39 ,-., Table III. cont. Lead 3 25 28 1 39 19 41 42 64 67 72 79 6.9 6.6 14.0 11.4 16.1 2.5 2.5 5.0 22.3 12.1 9.2 4.4 5.5 .9 1.2 .8 19.9 9.1 10.0 .05 2.8 2.6 * * * * * * * * * * * Lead 4 25 28 1 39 19 41 42 64 87 72 79 11.1 13.2 12.3 13.2 .8 6.7 10.1 10.0 17.2 14.1 9.9 .9 1.0 2.9 1.0 27.7 3.9 1.7 1.7 .8 1.7 4.4 * * * * * * * * * * * Lead 5 25 28 1 39 19 41 42 64 67 72 79 7.1 14.4 27.5 8.7 13.4 16.9 3.7 11.2 23.3 15.7 8.2 3.8 1.5 .2 4.1 .8 .7 12.0 2.1 .04 1.4 3.9 * * * * * * * * '* * * 40 - Table III. cont. Lead 6 25 28 1 39 19 41 42 64 67 72 79 4.6 1.7 10.9 13.2 17.8 .7 5.3 .8 19.6 8.4 16.6 4.3 5.9 3.4 .7 .5 73.2 .~ 3.8 43.8 .3 4.4 1.4 * * * * * * * * * * * Lead 7. ,- 25 28 1 39 19 41 42 64 67 72 79 15.3 16.9 11.3 21.4 23.8 15.9 15.5 14.7 19.9 27.2 1.4 1.3 1.0 .8 .2 .6 1.2 2.3 .5 1.0 X X * * * * * * * * * * * Lead 8 25 28 1 39 19 41 42 64 67 72 79 16.1 15.1 5.4 20.8 27.9 21.6 16.9 8.3 19.2 26.7 9.6 1.8 2.3 2.8 1.6 .2 .3 .6 9.8 .4 .4 7.6 * * * * * * * * * * * 41 -, Table III. cont. Lead 9 25 28 1 39 19 41 42 64 67 72 79 4.9 1.6 5.9 11.0 24.8 27.2 17.8 4.9 20.7 .6 7.5 11.6 30.8 3.7 1.6 .4 .3 .2 13.8 * * * * * * * .5 35.6 6.8 * * * * Lead 10 25 28 1 39 19 41 42 64 67 72 79 1.8 4.3 16.5 19.4 21.7 17.9 7.5 2.4 .4 .4 X X 10.7 4.5 18.4 7.7 6.5 3.4 7.9 .2 2.9 7.0 * * * * * * * * * * Lead 11 25 28 1 39 19 41 42 64 67 72 79 8.2 15.2 20.5 19.2 7.1 3.7 12.3 8.2 15.0 12.1 7.8 2.6 1.1 1.3 .4 2.0 6.0 1.9 2.3 .6 1.9 5.7 * * * * * * * * * * * 42 Table III. cont. ,.-, Lead 12 25 28 1 39 19 41 42 64 67 72 79 - 15.2 16.8 23.7 17.6 3.0 6.4 12.3 9.9 9.4 13.5 5.7 1.8 .7 .8 .4 3.7 3.2 1.4 1.6 2.4 1.7 7.8 * * * * * * * * * * *