Deriving a Reduced Lead System from the 80-Lead Body Surface Map in the Electrocardiographic Determination of Acute Myocardial Infarction.

PJ Scott, M Stevenson, C Navarro, A Hamilton, JR Bennett, C Owens, G Manoharan, OJ Escalona, JMCC Anderson, AAJ Adgey

Research output: Chapter in Book/Report/Conference proceedingConference contribution

Abstract

Background: Body 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 from15 tomore 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.Methods: We analyzed 576 patients with acute myocardial infarction (MI) (242 anterior, 173 inferior, 69 lateral, 69 posterior, and 23 right ventricular; peak cardiac troponin T N 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.Results: Thus, 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 forMIwas 84% and 97%, respectively, compared with the 80-leadBSMof 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) forthe 30-lead set and 0.782 (0.739-0.825) for the 80-lead set.Conclusion: Using the ROC c statistic, we showed that the 30-lead BSM was noninferior to the 80-lead model.
LanguageEnglish
Title of host publicationUnknown Host Publication
PublisherElsevier
Pages640-641
Volume41
Publication statusPublished - 15 Dec 2008

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Myocardial Infarction
ROC Curve
Body Surface Potential Mapping
Electrocardiography
Lead
Electrodes
Confidence Intervals
Sensitivity and Specificity
Troponin T
Chest Pain
Analysis of Variance
Thorax
Logistic Models
Regression Analysis

Keywords

  • Electrocardiography
  • accute myocardial infarction
  • BSPM
  • Cardiac mapping
  • 28-lead harness
  • chest pain
  • esrly diagnosis of AMI

Cite this

Scott, PJ., Stevenson, M., Navarro, C., Hamilton, A., Bennett, JR., Owens, C., ... Adgey, AAJ. (2008). Deriving a Reduced Lead System from the 80-Lead Body Surface Map in the Electrocardiographic Determination of Acute Myocardial Infarction. In Unknown Host Publication (Vol. 41, pp. 640-641). Elsevier.
Scott, PJ ; Stevenson, M ; Navarro, C ; Hamilton, A ; Bennett, JR ; Owens, C ; Manoharan, G ; Escalona, OJ ; Anderson, JMCC ; Adgey, AAJ. / Deriving a Reduced Lead System from the 80-Lead Body Surface Map in the Electrocardiographic Determination of Acute Myocardial Infarction. Unknown Host Publication. Vol. 41 Elsevier, 2008. pp. 640-641
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abstract = "Background: Body 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 from15 tomore 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.Methods: We analyzed 576 patients with acute myocardial infarction (MI) (242 anterior, 173 inferior, 69 lateral, 69 posterior, and 23 right ventricular; peak cardiac troponin T N 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.Results: Thus, 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 forMIwas 84{\%} and 97{\%}, respectively, compared with the 80-leadBSMof 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) forthe 30-lead set and 0.782 (0.739-0.825) for the 80-lead set.Conclusion: Using the ROC c statistic, we showed that the 30-lead BSM was noninferior to the 80-lead model.",
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Scott, PJ, Stevenson, M, Navarro, C, Hamilton, A, Bennett, JR, Owens, C, Manoharan, G, Escalona, OJ, Anderson, JMCC & Adgey, AAJ 2008, Deriving a Reduced Lead System from the 80-Lead Body Surface Map in the Electrocardiographic Determination of Acute Myocardial Infarction. in Unknown Host Publication. vol. 41, Elsevier, pp. 640-641.

Deriving a Reduced Lead System from the 80-Lead Body Surface Map in the Electrocardiographic Determination of Acute Myocardial Infarction. / Scott, PJ; Stevenson, M; Navarro, C; Hamilton, A; Bennett, JR; Owens, C; Manoharan, G; Escalona, OJ; Anderson, JMCC; Adgey, AAJ.

Unknown Host Publication. Vol. 41 Elsevier, 2008. p. 640-641.

Research output: Chapter in Book/Report/Conference proceedingConference contribution

TY - GEN

T1 - Deriving a Reduced Lead System from the 80-Lead Body Surface Map in the Electrocardiographic Determination of Acute Myocardial Infarction.

AU - Scott, PJ

AU - Stevenson, M

AU - Navarro, C

AU - Hamilton, A

AU - Bennett, JR

AU - Owens, C

AU - Manoharan, G

AU - Escalona, OJ

AU - Anderson, JMCC

AU - Adgey, AAJ

PY - 2008/12/15

Y1 - 2008/12/15

N2 - Background: Body 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 from15 tomore 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.Methods: We analyzed 576 patients with acute myocardial infarction (MI) (242 anterior, 173 inferior, 69 lateral, 69 posterior, and 23 right ventricular; peak cardiac troponin T N 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.Results: Thus, 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 forMIwas 84% and 97%, respectively, compared with the 80-leadBSMof 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) forthe 30-lead set and 0.782 (0.739-0.825) for the 80-lead set.Conclusion: Using the ROC c statistic, we showed that the 30-lead BSM was noninferior to the 80-lead model.

AB - Background: Body 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 from15 tomore 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.Methods: We analyzed 576 patients with acute myocardial infarction (MI) (242 anterior, 173 inferior, 69 lateral, 69 posterior, and 23 right ventricular; peak cardiac troponin T N 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.Results: Thus, 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 forMIwas 84% and 97%, respectively, compared with the 80-leadBSMof 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) forthe 30-lead set and 0.782 (0.739-0.825) for the 80-lead set.Conclusion: Using the ROC c statistic, we showed that the 30-lead BSM was noninferior to the 80-lead model.

KW - Electrocardiography

KW - accute myocardial infarction

KW - BSPM

KW - Cardiac mapping

KW - 28-lead harness

KW - chest pain

KW - esrly diagnosis of AMI

M3 - Conference contribution

VL - 41

SP - 640

EP - 641

BT - Unknown Host Publication

PB - Elsevier

ER -

Scott PJ, Stevenson M, Navarro C, Hamilton A, Bennett JR, Owens C et al. Deriving a Reduced Lead System from the 80-Lead Body Surface Map in the Electrocardiographic Determination of Acute Myocardial Infarction. In Unknown Host Publication. Vol. 41. Elsevier. 2008. p. 640-641