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

    48 Citations (Scopus)

    Abstract

    Objective: To test prospectively depoiarisation 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. Methods: 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+/-15degree-findings typically seen in LBBB with AMI. Results: 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+/-15degree), particularly between QRS isointegral and ST60 isopotential (the potential 60 ms after the J point at each electrode site) BSMs (19degree v 9degree, p = 0.038). Loss of image reversal and QRS-ST60 vector change outside 180+/-15degree had 61% sensitivity and 82% specificity for AMI (odds ratio 7.0, 95% confidence interval 2.0 to 24.4, p = 0.001). Conclusions: BSM compared with the 12 lead ECG improved the early diagnosis of AMI in the presence of LBBB.
    LanguageEnglish
    Pages998-1002
    JournalHeart
    Volume89
    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

    • acute heart infarction/di [Diagnosis]
    • adult
    • aged
    • article
    • artifact
    • body surface
    • early diagnosis
    • electrocardiogram
    • female
    • heart depolarization
    • heart left bundle branch block
    • heart repolarization
    • human
    • major clinical study
    • male
    • priority journal
    • QRS complex
    • sensitivity and specificity
    • thorax pain
    • heart enzyme/ec [Endogenous Compound]

    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, 89(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. 2003 ; Vol. 89, No. 9. pp. 998-1002.
    @article{0b85544c2bba411a81e32038d1f6e4aa,
    title = "Body surface mapping improves early diagnosis of acute myocardial infarction in patients with chest pain and left bundle branch block.",
    abstract = "Objective: To test prospectively depoiarisation 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. Methods: 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+/-15degree-findings typically seen in LBBB with AMI. Results: 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+/-15degree), particularly between QRS isointegral and ST60 isopotential (the potential 60 ms after the J point at each electrode site) BSMs (19degree v 9degree, p = 0.038). Loss of image reversal and QRS-ST60 vector change outside 180+/-15degree had 61{\%} sensitivity and 82{\%} specificity for AMI (odds ratio 7.0, 95{\%} confidence interval 2.0 to 24.4, p = 0.001). Conclusions: BSM compared with the 12 lead ECG improved the early diagnosis of AMI in the presence of LBBB.",
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    author = "SJ Maynard and IBA Menown and G Manoharan and J Allen and JMCC Anderson and AAJ Adgey",
    year = "2003",
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    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, vol. 89, 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, Vol. 89, 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

    PY - 2003

    Y1 - 2003

    N2 - Objective: To test prospectively depoiarisation 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. Methods: 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+/-15degree-findings typically seen in LBBB with AMI. Results: 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+/-15degree), particularly between QRS isointegral and ST60 isopotential (the potential 60 ms after the J point at each electrode site) BSMs (19degree v 9degree, p = 0.038). Loss of image reversal and QRS-ST60 vector change outside 180+/-15degree had 61% sensitivity and 82% specificity for AMI (odds ratio 7.0, 95% confidence interval 2.0 to 24.4, p = 0.001). Conclusions: BSM compared with the 12 lead ECG improved the early diagnosis of AMI in the presence of LBBB.

    AB - Objective: To test prospectively depoiarisation 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. Methods: 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+/-15degree-findings typically seen in LBBB with AMI. Results: 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+/-15degree), particularly between QRS isointegral and ST60 isopotential (the potential 60 ms after the J point at each electrode site) BSMs (19degree v 9degree, p = 0.038). Loss of image reversal and QRS-ST60 vector change outside 180+/-15degree had 61% sensitivity and 82% specificity for AMI (odds ratio 7.0, 95% confidence interval 2.0 to 24.4, p = 0.001). Conclusions: BSM compared with the 12 lead ECG improved the early diagnosis of AMI in the presence of LBBB.

    KW - acute heart infarction/di [Diagnosis]

    KW - adult

    KW - aged

    KW - article

    KW - artifact

    KW - body surface

    KW - early diagnosis

    KW - electrocardiogram

    KW - female

    KW - heart depolarization

    KW - heart left bundle branch block

    KW - heart repolarization

    KW - human

    KW - major clinical study

    KW - male

    KW - priority journal

    KW - QRS complex

    KW - sensitivity and specificity

    KW - thorax pain

    KW - heart enzyme/ec [Endogenous Compound]

    M3 - Article

    VL - 89

    SP - 998

    EP - 1002

    JO - Heart

    T2 - Heart

    JF - Heart

    SN - 1355-6037

    IS - 9

    ER -

    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. Heart. 2003;89(9):998-1002.