Comparison of the 80-lead body surface map to physician and to 12-lead electrocardiogram in detection of acute myocardial infarction
Comparison of the 80-lead body surface map to physician and to 12-lead electrocardiogram in detection of acute myocardial infarction
Diagnosis of non-ST-elevation acute myocardial infarction (AMI) by a 12-lead electrocardiogram has poor sensitivity and specificity and, therefore, relies on biochemical markers of myocardial necrosis, which can only be reliably detected within 14 to 16 hours from symptom onset. The body surface map (BSM) improves AMI detection but is limited by its interpretation by inexperienced medical staff. To facilitate interpretation, an automated BSM algorithm was developed and is evaluated in this study. One hundred three patients with ischemic-type chest pain were recruited for this study from December 2001 to April 2002. A 12-lead electrocardiogram (Marquette Mac 5K) and BSM (PRIME-ECG) were recorded at initial presentation, and cardiac troponin I and/or creatine kinase-MB levels measured at 12 hours after symptom onset. The admitting physician's 12-lead electrocardiographic (ECG) interpretation, 12-lead ECG algorithm (Marquette 12 SL V233) diagnosis, and BSM algorithm diagnosis were documented for each patient. AMI, defined by elevation of troponin I to >1 microg/L and/or creatine kinase-MB to >25U/L, occurred in 53 patients. The admitting physician diagnosed 24 patients with AMI (sensitivity 45%, specificity 94%), the 12-lead ECG algorithm diagnosed 17 patients with AMI (sensitivity 32%, specificity 98%), and the BSM algorithm diagnosed 34 patients with AMI (sensitivity 64%, specificity 94%). The BSM algorithm improved the diagnostic sensitivity by 2.0 (p <0.001) and 1.4 (p = 0.002) compared with the 12-lead ECG algorithm or the admitting physician, respectively. There was no significant difference in specificity. Thus, the BSM algorithm improves detection of AMI compared with the 12-lead ECG algorithm or physician's 12-lead ECG interpretation.
Aged, Algorithms, Automation, Biomarkers, Body Surface Potential Mapping, Creatine Kinase, Electrocardiography, Female, Humans, Male, Middle Aged, Myocardial Infarction, Physicians, Predictive Value of Tests, Sensitivity and Specificity, Troponin I, Clinical Trial, Comparative Study, Journal Article, Research Support, Non-U.S. Gov't
252-7
McClelland, Anthony J J
05f45be5-507d-42b3-9bfb-e4c6939ad2f6
Owens, Colum G
26345a83-afc1-4579-9754-029c44e1a4f2
Menown, Ian B A
0d1b8124-5458-4d32-a251-4bcd1db08fc0
Lown, Mark
4742d5f8-bcf3-4e0b-811c-920e7d010c9b
Adgey, A A Jennifer
858c399b-c3cb-4fed-95dd-2934de0c7893
1 August 2003
McClelland, Anthony J J
05f45be5-507d-42b3-9bfb-e4c6939ad2f6
Owens, Colum G
26345a83-afc1-4579-9754-029c44e1a4f2
Menown, Ian B A
0d1b8124-5458-4d32-a251-4bcd1db08fc0
Lown, Mark
4742d5f8-bcf3-4e0b-811c-920e7d010c9b
Adgey, A A Jennifer
858c399b-c3cb-4fed-95dd-2934de0c7893
McClelland, Anthony J J, Owens, Colum G, Menown, Ian B A, Lown, Mark and Adgey, A A Jennifer
(2003)
Comparison of the 80-lead body surface map to physician and to 12-lead electrocardiogram in detection of acute myocardial infarction.
The American Journal of Cardiology, 92 (3), .
(doi:10.1016/S0002-9149(03)00619-2).
Abstract
Diagnosis of non-ST-elevation acute myocardial infarction (AMI) by a 12-lead electrocardiogram has poor sensitivity and specificity and, therefore, relies on biochemical markers of myocardial necrosis, which can only be reliably detected within 14 to 16 hours from symptom onset. The body surface map (BSM) improves AMI detection but is limited by its interpretation by inexperienced medical staff. To facilitate interpretation, an automated BSM algorithm was developed and is evaluated in this study. One hundred three patients with ischemic-type chest pain were recruited for this study from December 2001 to April 2002. A 12-lead electrocardiogram (Marquette Mac 5K) and BSM (PRIME-ECG) were recorded at initial presentation, and cardiac troponin I and/or creatine kinase-MB levels measured at 12 hours after symptom onset. The admitting physician's 12-lead electrocardiographic (ECG) interpretation, 12-lead ECG algorithm (Marquette 12 SL V233) diagnosis, and BSM algorithm diagnosis were documented for each patient. AMI, defined by elevation of troponin I to >1 microg/L and/or creatine kinase-MB to >25U/L, occurred in 53 patients. The admitting physician diagnosed 24 patients with AMI (sensitivity 45%, specificity 94%), the 12-lead ECG algorithm diagnosed 17 patients with AMI (sensitivity 32%, specificity 98%), and the BSM algorithm diagnosed 34 patients with AMI (sensitivity 64%, specificity 94%). The BSM algorithm improved the diagnostic sensitivity by 2.0 (p <0.001) and 1.4 (p = 0.002) compared with the 12-lead ECG algorithm or the admitting physician, respectively. There was no significant difference in specificity. Thus, the BSM algorithm improves detection of AMI compared with the 12-lead ECG algorithm or physician's 12-lead ECG interpretation.
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Published date: 1 August 2003
Keywords:
Aged, Algorithms, Automation, Biomarkers, Body Surface Potential Mapping, Creatine Kinase, Electrocardiography, Female, Humans, Male, Middle Aged, Myocardial Infarction, Physicians, Predictive Value of Tests, Sensitivity and Specificity, Troponin I, Clinical Trial, Comparative Study, Journal Article, Research Support, Non-U.S. Gov't
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Local EPrints ID: 425997
URI: http://eprints.soton.ac.uk/id/eprint/425997
ISSN: 0002-9149
PURE UUID: ab347153-1d1f-4f76-994d-75adcc7c2f93
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Date deposited: 09 Nov 2018 17:30
Last modified: 11 Jul 2024 01:53
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Contributors
Author:
Anthony J J McClelland
Author:
Colum G Owens
Author:
Ian B A Menown
Author:
A A Jennifer Adgey
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