Body surface mapping improves early diagnosis of acute myocardial infarction in patients with chest pain and left bundle branch block

SJ Maynard, IBA Menown, G Manoharan, J Allen, JMCC Anderson, AAJ Adgey

    Research output: Contribution to journalArticle

    Abstract

    To test prospectively depolarisation and repolarisation body surface maps (BSMs) for mirror image reversal, which is less susceptible to artefact, in patients with acute ischaemic-type chest pain, and to compare these BSM criteria with previously published 12 lead ECG criteria.An 80 lead portable BSM system was used to map patients presenting with acute ischaemic-type chest pain and a 12 lead ECG with left bundle branch block (LBBB). Acute myocardial infarction (AMI) was defined by serial cardiac enzymes. Each 12 lead ECG was assessed by the criteria of Sgarbossa et al and Hands et al for diagnosis of AMI. Depolarisation and repolarisation BSMs were assessed for loss of mirror image reversal of QRS with ST-T isointegral map patterns and a change in vector angle from QRS to ST-T outside 180+/-15 degrees -findings typically seen in LBBB with AMI.Of 56 patients with chest pain and LBBB, 18 had enzymatically confirmed AMI. Patients with loss of BSM image reversal were significantly more likely to have AMI (odds ratio 4.9, 95% confidence interval 1.5 to 16.4, p = 0.007). Loss of BSM image reversal was significantly more sensitive (67%) for AMI than either 12 lead ECG method (17%, 33%) albeit with some loss in specificity (BSM 71%, 12 lead ECG 87%, 97%). Patients with AMI compared with those without AMI had a greater mean change in vector angle outside the normal range (180+/-15 degrees ), particularly between QRS isointegral and ST60 isopotential (the potential 60 ms after the J point at each electrode site) BSMs (19 degrees v 9 degrees, p = 0.038). Loss of image reversal and QRS-ST60 vector change outside 180+/-15 degrees had 61% sensitivity and 82% specificity for AMI (odds ratio 7.0, 95% confidence interval 2.0 to 24.4, p = 0.001).BSM compared with the 12 lead ECG improved the early diagnosis of AMI in the presence of LBBB.
    LanguageEnglish
    Pages998-1002
    JournalHeart (British Cardiac Society)
    VolumePMC176
    Issue number9
    Publication statusPublished - 2003

    Fingerprint

    Body Surface Potential Mapping
    Bundle-Branch Block
    Chest Pain
    Early Diagnosis
    Myocardial Infarction
    Electrocardiography
    Odds Ratio
    Confidence Intervals
    Artifacts
    Lead
    Electrodes
    Reference Values

    Keywords

    • Adult
    • Aged
    • 80 and over
    • Body Surface Potential Mapping
    • Bundle-Branch Block: diagnosis
    • Chest Pain: etiology
    • Female
    • Humans
    • Male
    • Middle Aged
    • Myocardial Infarction: diagnosis
    • Prospective Studies
    • Time Factors

    Cite this

    Maynard, SJ., Menown, IBA., Manoharan, G., Allen, J., Anderson, JMCC., & Adgey, AAJ. (2003). Body surface mapping improves early diagnosis of acute myocardial infarction in patients with chest pain and left bundle branch block. Heart (British Cardiac Society), PMC176(9), 998-1002.
    Maynard, SJ ; Menown, IBA ; Manoharan, G ; Allen, J ; Anderson, JMCC ; Adgey, AAJ. / Body surface mapping improves early diagnosis of acute myocardial infarction in patients with chest pain and left bundle branch block. In: Heart (British Cardiac Society). 2003 ; Vol. PMC176, No. 9. pp. 998-1002.
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    abstract = "To test prospectively depolarisation and repolarisation body surface maps (BSMs) for mirror image reversal, which is less susceptible to artefact, in patients with acute ischaemic-type chest pain, and to compare these BSM criteria with previously published 12 lead ECG criteria.An 80 lead portable BSM system was used to map patients presenting with acute ischaemic-type chest pain and a 12 lead ECG with left bundle branch block (LBBB). Acute myocardial infarction (AMI) was defined by serial cardiac enzymes. Each 12 lead ECG was assessed by the criteria of Sgarbossa et al and Hands et al for diagnosis of AMI. Depolarisation and repolarisation BSMs were assessed for loss of mirror image reversal of QRS with ST-T isointegral map patterns and a change in vector angle from QRS to ST-T outside 180+/-15 degrees -findings typically seen in LBBB with AMI.Of 56 patients with chest pain and LBBB, 18 had enzymatically confirmed AMI. Patients with loss of BSM image reversal were significantly more likely to have AMI (odds ratio 4.9, 95{\%} confidence interval 1.5 to 16.4, p = 0.007). Loss of BSM image reversal was significantly more sensitive (67{\%}) for AMI than either 12 lead ECG method (17{\%}, 33{\%}) albeit with some loss in specificity (BSM 71{\%}, 12 lead ECG 87{\%}, 97{\%}). Patients with AMI compared with those without AMI had a greater mean change in vector angle outside the normal range (180+/-15 degrees ), particularly between QRS isointegral and ST60 isopotential (the potential 60 ms after the J point at each electrode site) BSMs (19 degrees v 9 degrees, p = 0.038). Loss of image reversal and QRS-ST60 vector change outside 180+/-15 degrees had 61{\%} sensitivity and 82{\%} specificity for AMI (odds ratio 7.0, 95{\%} confidence interval 2.0 to 24.4, p = 0.001).BSM compared with the 12 lead ECG improved the early diagnosis of AMI in the presence of LBBB.",
    keywords = "Adult, Aged, 80 and over, Body Surface Potential Mapping, Bundle-Branch Block: diagnosis, Chest Pain: etiology, Female, Humans, Male, Middle Aged, Myocardial Infarction: diagnosis, Prospective Studies, Time Factors",
    author = "SJ Maynard and IBA Menown and G Manoharan and J Allen and JMCC Anderson and AAJ Adgey",
    note = "Cites: Lancet. 1994 Feb 5;343(8893):311-22[7905143]; Cites: Eur Heart J. 1993 Aug;14(8):1094-101[8404940]; Cites: J Electrocardiol. 1993 Jul;26(3):187-96[8409813]; Cites: N Engl J Med. 1996 Feb 22;334(8):481-7[8559200]; Cites: Circulation. 1996 Nov 15;94(10):2424-8[8921783]; Cites: Ann Intern Med. 1998 Nov 1;129(9):690-7[9841600]; Cites: Cardiol Clin. 1987 Aug;5(3):393-401[3690603]; Cites: JAMA. 1999 Feb 24;281(8):714-9[10052441]; Cites: Scand Cardiovasc J. 1999;33(1):17-22[10093854]; Cites: J Accid Emerg Med. 1999 Sep;16(5):331-5[10505911]; Cites: Am J Cardiol. 2000 Apr 15;85(8):934-8[10760329]; Cites: Clin Cardiol. 2001 Oct;24(10):652-5[11594410]; Cites: Am Heart J. 1988 Jul;116(1 Pt 1):23-31[3394629]; Cites: J Electrocardiol. 1998;31 Suppl:180-8[9988026]; LR: 20091118RX: 850816 (on Jul 22, 2011)",
    year = "2003",
    language = "English",
    volume = "PMC176",
    pages = "998--1002",
    journal = "Heart",
    issn = "1355-6037",
    number = "9",

    }

    Maynard, SJ, Menown, IBA, Manoharan, G, Allen, J, Anderson, JMCC & Adgey, AAJ 2003, 'Body surface mapping improves early diagnosis of acute myocardial infarction in patients with chest pain and left bundle branch block', Heart (British Cardiac Society), vol. PMC176, no. 9, pp. 998-1002.

    Body surface mapping improves early diagnosis of acute myocardial infarction in patients with chest pain and left bundle branch block. / Maynard, SJ; Menown, IBA; Manoharan, G; Allen, J; Anderson, JMCC; Adgey, AAJ.

    In: Heart (British Cardiac Society), Vol. PMC176, No. 9, 2003, p. 998-1002.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - Body surface mapping improves early diagnosis of acute myocardial infarction in patients with chest pain and left bundle branch block

    AU - Maynard, SJ

    AU - Menown, IBA

    AU - Manoharan, G

    AU - Allen, J

    AU - Anderson, JMCC

    AU - Adgey, AAJ

    N1 - Cites: Lancet. 1994 Feb 5;343(8893):311-22[7905143]; Cites: Eur Heart J. 1993 Aug;14(8):1094-101[8404940]; Cites: J Electrocardiol. 1993 Jul;26(3):187-96[8409813]; Cites: N Engl J Med. 1996 Feb 22;334(8):481-7[8559200]; Cites: Circulation. 1996 Nov 15;94(10):2424-8[8921783]; Cites: Ann Intern Med. 1998 Nov 1;129(9):690-7[9841600]; Cites: Cardiol Clin. 1987 Aug;5(3):393-401[3690603]; Cites: JAMA. 1999 Feb 24;281(8):714-9[10052441]; Cites: Scand Cardiovasc J. 1999;33(1):17-22[10093854]; Cites: J Accid Emerg Med. 1999 Sep;16(5):331-5[10505911]; Cites: Am J Cardiol. 2000 Apr 15;85(8):934-8[10760329]; Cites: Clin Cardiol. 2001 Oct;24(10):652-5[11594410]; Cites: Am Heart J. 1988 Jul;116(1 Pt 1):23-31[3394629]; Cites: J Electrocardiol. 1998;31 Suppl:180-8[9988026]; LR: 20091118RX: 850816 (on Jul 22, 2011)

    PY - 2003

    Y1 - 2003

    N2 - To test prospectively depolarisation and repolarisation body surface maps (BSMs) for mirror image reversal, which is less susceptible to artefact, in patients with acute ischaemic-type chest pain, and to compare these BSM criteria with previously published 12 lead ECG criteria.An 80 lead portable BSM system was used to map patients presenting with acute ischaemic-type chest pain and a 12 lead ECG with left bundle branch block (LBBB). Acute myocardial infarction (AMI) was defined by serial cardiac enzymes. Each 12 lead ECG was assessed by the criteria of Sgarbossa et al and Hands et al for diagnosis of AMI. Depolarisation and repolarisation BSMs were assessed for loss of mirror image reversal of QRS with ST-T isointegral map patterns and a change in vector angle from QRS to ST-T outside 180+/-15 degrees -findings typically seen in LBBB with AMI.Of 56 patients with chest pain and LBBB, 18 had enzymatically confirmed AMI. Patients with loss of BSM image reversal were significantly more likely to have AMI (odds ratio 4.9, 95% confidence interval 1.5 to 16.4, p = 0.007). Loss of BSM image reversal was significantly more sensitive (67%) for AMI than either 12 lead ECG method (17%, 33%) albeit with some loss in specificity (BSM 71%, 12 lead ECG 87%, 97%). Patients with AMI compared with those without AMI had a greater mean change in vector angle outside the normal range (180+/-15 degrees ), particularly between QRS isointegral and ST60 isopotential (the potential 60 ms after the J point at each electrode site) BSMs (19 degrees v 9 degrees, p = 0.038). Loss of image reversal and QRS-ST60 vector change outside 180+/-15 degrees had 61% sensitivity and 82% specificity for AMI (odds ratio 7.0, 95% confidence interval 2.0 to 24.4, p = 0.001).BSM compared with the 12 lead ECG improved the early diagnosis of AMI in the presence of LBBB.

    AB - To test prospectively depolarisation and repolarisation body surface maps (BSMs) for mirror image reversal, which is less susceptible to artefact, in patients with acute ischaemic-type chest pain, and to compare these BSM criteria with previously published 12 lead ECG criteria.An 80 lead portable BSM system was used to map patients presenting with acute ischaemic-type chest pain and a 12 lead ECG with left bundle branch block (LBBB). Acute myocardial infarction (AMI) was defined by serial cardiac enzymes. Each 12 lead ECG was assessed by the criteria of Sgarbossa et al and Hands et al for diagnosis of AMI. Depolarisation and repolarisation BSMs were assessed for loss of mirror image reversal of QRS with ST-T isointegral map patterns and a change in vector angle from QRS to ST-T outside 180+/-15 degrees -findings typically seen in LBBB with AMI.Of 56 patients with chest pain and LBBB, 18 had enzymatically confirmed AMI. Patients with loss of BSM image reversal were significantly more likely to have AMI (odds ratio 4.9, 95% confidence interval 1.5 to 16.4, p = 0.007). Loss of BSM image reversal was significantly more sensitive (67%) for AMI than either 12 lead ECG method (17%, 33%) albeit with some loss in specificity (BSM 71%, 12 lead ECG 87%, 97%). Patients with AMI compared with those without AMI had a greater mean change in vector angle outside the normal range (180+/-15 degrees ), particularly between QRS isointegral and ST60 isopotential (the potential 60 ms after the J point at each electrode site) BSMs (19 degrees v 9 degrees, p = 0.038). Loss of image reversal and QRS-ST60 vector change outside 180+/-15 degrees had 61% sensitivity and 82% specificity for AMI (odds ratio 7.0, 95% confidence interval 2.0 to 24.4, p = 0.001).BSM compared with the 12 lead ECG improved the early diagnosis of AMI in the presence of LBBB.

    KW - Adult

    KW - Aged

    KW - 80 and over

    KW - Body Surface Potential Mapping

    KW - Bundle-Branch Block: diagnosis

    KW - Chest Pain: etiology

    KW - Female

    KW - Humans

    KW - Male

    KW - Middle Aged

    KW - Myocardial Infarction: diagnosis

    KW - Prospective Studies

    KW - Time Factors

    M3 - Article

    VL - PMC176

    SP - 998

    EP - 1002

    JO - Heart

    T2 - Heart

    JF - Heart

    SN - 1355-6037

    IS - 9

    ER -