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

PJ Scott, M Stevenson, M Giardina, A Hamilton, JJ Bennett, G Owen, G Manoharan, OJ Escalona, JMCC Anderson, J Adgey

Research output: Contribution to journalArticle

Abstract

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.
LanguageEnglish
Pages640-641
JournalJournal of Electrocardiology
Volume41
Issue number6
DOIs
Publication statusPublished - 1 Nov 2008

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

Keywords

  • Electrocardiography
  • Body surface potential mapping
  • myocardial infarction
  • ECG leads optimisation
  • MI diagnosis
  • ROC curve analysis.

Cite this

Scott, PJ ; Stevenson, M ; Giardina, M ; Hamilton, A ; Bennett, JJ ; Owen, G ; Manoharan, G ; Escalona, OJ ; Anderson, JMCC ; Adgey, J. / Deriving a reduced lead system from the 80-lead body surface map in the electrocardiographic determination of acute myocardial infarction. In: Journal of Electrocardiology. 2008 ; Vol. 41, No. 6. pp. 640-641.
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title = "Deriving a reduced lead system from the 80-lead body surface map in the electrocardiographic determination of acute myocardial infarction",
abstract = "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.",
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Scott, PJ, Stevenson, M, Giardina, M, Hamilton, A, Bennett, JJ, Owen, G, Manoharan, G, Escalona, OJ, Anderson, JMCC & 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, vol. 41, no. 6, pp. 640-641. https://doi.org/10.1016/j.jelectrocard.2008.08.018

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; Adgey, J.

In: Journal of Electrocardiology, Vol. 41, No. 6, 01.11.2008, p. 640-641.

Research output: Contribution to journalArticle

TY - JOUR

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 - Giardina, M

AU - Hamilton, A

AU - Bennett, JJ

AU - Owen, G

AU - Manoharan, G

AU - Escalona, OJ

AU - Anderson, JMCC

AU - Adgey, J

PY - 2008/11/1

Y1 - 2008/11/1

N2 - 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.

AB - 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.

KW - Electrocardiography

KW - Body surface potential mapping

KW - myocardial infarction

KW - ECG leads optimisation

KW - MI diagnosis

KW - ROC curve analysis.

U2 - 10.1016/j.jelectrocard.2008.08.018

DO - 10.1016/j.jelectrocard.2008.08.018

M3 - Article

VL - 41

SP - 640

EP - 641

JO - Journal of Electrocardiology

T2 - Journal of Electrocardiology

JF - Journal of Electrocardiology

SN - 0022-0736

IS - 6

ER -