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Deriving a reduced lead system from the 80-lead body surface map in the electrocardiographic determination of acute myocardial infarction

Scott, PJ, Stevenson, M, Giardina, M, Hamilton, A, Bennett, JJ, Owen, G, Manoharan, G, Escalona, OJ, Anderson, JMCC and Adgey, J (2008) Deriving a reduced lead system from the 80-lead body surface map in the electrocardiographic determination of acute myocardial infarction. Journal of Electrocardiology, 41 (6). pp. 640-641. [Journal article]

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URL: http://www.sciencedirect.com/science/article/pii/S0022073608003233

DOI: 10.1016/j.jelectrocard.2008.08.018


BackgroundBody surface mapping (BSM) involves the application of extra electrodes or “nonstandard lead sets” over a larger area of the thorax than the routine 12-lead electrocardiogram (ECG). The number of electrodes can range from 15 to more than 250, and the optimum number and placement of leads is a major topic of research. We used a novel retrospective approach, analyzing the records from patients admitted to our center with acute ischemic-type chest pain, to determine optimum lead number and placement.MethodsWe analyzed 576 patients with acute myocardial infarction (MI) (242 anterior, 173 inferior, 69 lateral, 69 posterior, and 23 right ventricular; peak cardiac troponin T > 0.09 nmol/L) and 279 controls (normal ECG and cardiac markers). Infarct location was verified by 2 cardiologists not involved in the study. Initially, an 80-lead (64 anterior, 16 posterior) BSM (Prime ECG) was recorded on all patients prior to revascularization. A combined method of analysis for a reduced lead set was used—analysis of variance (ANOVA) determined which leads had the greatest mean ST elevation (ST0 [mm]), logistic regression analysis of the ST0 ranked each lead in terms of MI diagnosis, and a computer algorithm determined which leads in combination produced the greatest sensitivity and specificity for MI diagnosis.ResultsThus, a 30-lead set (20 anterior, 10 posterior) was derived from the combined method of analysis. The sensitivity and specificity of the 30-lead set for MI was 84% and 97%, respectively, compared with the 80-lead BSM of 91% and 93%. Receiver operating characteristic (ROC) c statistic for the 30 lead set was 0.825 (95% confidence interval, 0.797-0.852), which was within the 95% confidence intervals for the 80 lead ROC c statistic of 0.850 (0.824-0.875). The data set was split equally into training and validation set. The training set ROC c statistic for the 30-lead set was 0.860 (0.825-0.896) and 0.908 (0.881-0.935) for the 80-lead set. The validation set ROC c statistic was 0.821 (0.782-0.860) for the 30-lead set and 0.782 (0.739-0.825) for the 80-lead set.ConclusionUsing the ROC c statistic, we showed that the 30-lead BSM was noninferior to the 80-lead model.

Item Type:Journal article
Keywords:Electrocardiography; Body surface potential mapping; myocardial infarction; ECG leads optimisation; MI diagnosis; ROC curve analysis.
Faculties and Schools:Faculty of Computing & Engineering
Faculty of Computing & Engineering > School of Engineering
Research Institutes and Groups:Engineering Research Institute
Engineering Research Institute > Nanotechnology & Integrated BioEngineering Centre (NIBEC)
ID Code:30037
Deposited By: Professor Omar Escalona
Deposited On:08 Feb 2016 14:27
Last Modified:08 Feb 2016 14:27

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