Improving The Diagnosis Of Acute Myocardial Infarction By Deriving Epicardial Potentials From The Body Surface Potential Map Using Inverse Electrocardiography And An Individualized Torso Model

Michael Daly; Dewar Finlay; Daniel Guldenring; Raymond Bond; Aaron McCann; Peter Scott; Jennifer Adgey; Mark Harbinson

doi:10.1016/S0735-1097(16)30656-8

Improving The Diagnosis Of Acute Myocardial Infarction By Deriving Epicardial Potentials From The Body Surface Potential Map Using Inverse Electrocardiography And An Individualized Torso Model

Michael Daly, Dewar Finlay, Daniel Guldenring, Raymond Bond, Aaron McCann, Peter Scott, Jennifer Adgey, Mark Harbinson

Research output: Chapter in Book/Report/Conference proceeding › Conference contribution › peer-review

Abstract

Epicardial potentials (EP) derived from the body surface potential map (BSPM) improve acute myocardial infarction (AMI) diagnosis. In this study, we compared EP derived from the 80-lead BSPM using a standard thoracic volume conductor model (TVCM) with those derived using a patient-specific torso model (PSTM) based on body mass index (BMI). Patients presenting to ED between August 2009 and August 2011 with acute ischaemic-type chest pain at rest were enrolled. At first medical contact, 12-lead ECG and BSPM were recorded. BMI for each patient was calculated. Cardiac troponin-T (cTnT) was sampled 12h after symptom onset. Patients were excluded from analysis if they had any electrocardiographic confounders to interpretation of the ST-segment. A cardiologist assessed the 12-lead ECG for STEMI by Minnesota criteria and BSPM. BSPM ST-elevation (STE) was ≥0.2mV in anterior, ≥0.1mV in lateral, inferior, RV or high right anterior and ≥0.05mV in posterior territories. To derive EP, the BSPM data were interpolated to yield values at 352-nodes of a Dalhousie torso. Using an inverse solution based on the boundary element method, EP at 98 cardiac nodes positioned within a standard TVCM were derived. The TVCM was then scaled to produce a PSTM, using a model developed from CT in 48 patients of varying BMI, and EP re-calculated. EP ≥0.3mV defined STE. A cardiologist blinded to both the 12-lead ECG and BSPM interpreted the EP map. AMI was defined as cTnT ≥0.1µg/L. Enrolled were 400 patients (age 62 ± 13 yrs; 57% male): 80 patients had exclusion criteria. Of the remaining 320 patients, BMI was 27.8 ± 5.6kg m-2. Of these, 180 (56%) had AMI. Overall, 132 had Minnesota STEMI on ECG (sensitivity 65%, sensitivity 89%) and 160 had BSPM STE (sensitivity 81%, specificity 90%). EP STE occurred in 165 patients using TVCM (sensitivity 88%, specificity 95%, p

Original language	English
Title of host publication	Unknown Host Publication
Publisher	American College of Cardiology
Number of pages	1
Volume	16
DOIs	https://doi.org/10.1016/S0735-1097(16)30656-8
Publication status	Published (in print/issue) - 5 Apr 2016
Event	American College of Cardiology - Chicago Duration: 5 Apr 2016 → …

Conference

Conference	American College of Cardiology
Period	5/04/16 → …

Keywords

cardiology
electrocardiogram
inverse electrocardiology
body surface potential maps
boundary element
myocardial infarction
heart
STEMI

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10.1016/S0735-1097(16)30656-8

Cite this

Daly, M., Finlay, D., Guldenring, D., Bond, R., McCann, A., Scott, P., Adgey, J., & Harbinson, M. (2016). Improving The Diagnosis Of Acute Myocardial Infarction By Deriving Epicardial Potentials From The Body Surface Potential Map Using Inverse Electrocardiography And An Individualized Torso Model. In Unknown Host Publication (Vol. 16). American College of Cardiology. https://doi.org/10.1016/S0735-1097(16)30656-8

@inproceedings{9c3d34ef00db4f309321754658a235aa,

title = "Improving The Diagnosis Of Acute Myocardial Infarction By Deriving Epicardial Potentials From The Body Surface Potential Map Using Inverse Electrocardiography And An Individualized Torso Model",

abstract = "Epicardial potentials (EP) derived from the body surface potential map (BSPM) improve acute myocardial infarction (AMI) diagnosis. In this study, we compared EP derived from the 80-lead BSPM using a standard thoracic volume conductor model (TVCM) with those derived using a patient-specific torso model (PSTM) based on body mass index (BMI). Patients presenting to ED between August 2009 and August 2011 with acute ischaemic-type chest pain at rest were enrolled. At first medical contact, 12-lead ECG and BSPM were recorded. BMI for each patient was calculated. Cardiac troponin-T (cTnT) was sampled 12h after symptom onset. Patients were excluded from analysis if they had any electrocardiographic confounders to interpretation of the ST-segment. A cardiologist assessed the 12-lead ECG for STEMI by Minnesota criteria and BSPM. BSPM ST-elevation (STE) was ≥0.2mV in anterior, ≥0.1mV in lateral, inferior, RV or high right anterior and ≥0.05mV in posterior territories. To derive EP, the BSPM data were interpolated to yield values at 352-nodes of a Dalhousie torso. Using an inverse solution based on the boundary element method, EP at 98 cardiac nodes positioned within a standard TVCM were derived. The TVCM was then scaled to produce a PSTM, using a model developed from CT in 48 patients of varying BMI, and EP re-calculated. EP ≥0.3mV defined STE. A cardiologist blinded to both the 12-lead ECG and BSPM interpreted the EP map. AMI was defined as cTnT ≥0.1µg/L. Enrolled were 400 patients (age 62 ± 13 yrs; 57% male): 80 patients had exclusion criteria. Of the remaining 320 patients, BMI was 27.8 ± 5.6kg m-2. Of these, 180 (56%) had AMI. Overall, 132 had Minnesota STEMI on ECG (sensitivity 65%, sensitivity 89%) and 160 had BSPM STE (sensitivity 81%, specificity 90%). EP STE occurred in 165 patients using TVCM (sensitivity 88%, specificity 95%, p",

keywords = "cardiology, electrocardiogram, inverse electrocardiology, body surface potential maps, boundary element, myocardial infarction, heart, STEMI",

author = "Michael Daly and Dewar Finlay and Daniel Guldenring and Raymond Bond and Aaron McCann and Peter Scott and Jennifer Adgey and Mark Harbinson",

year = "2016",

month = apr,

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doi = "10.1016/S0735-1097(16)30656-8",

language = "English",

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Daly, M, Finlay, D, Guldenring, D, Bond, R, McCann, A, Scott, P, Adgey, J & Harbinson, M 2016, Improving The Diagnosis Of Acute Myocardial Infarction By Deriving Epicardial Potentials From The Body Surface Potential Map Using Inverse Electrocardiography And An Individualized Torso Model. in Unknown Host Publication. vol. 16, American College of Cardiology, American College of Cardiology, 5/04/16. https://doi.org/10.1016/S0735-1097(16)30656-8

Improving The Diagnosis Of Acute Myocardial Infarction By Deriving Epicardial Potentials From The Body Surface Potential Map Using Inverse Electrocardiography And An Individualized Torso Model. / Daly, Michael; Finlay, Dewar; Guldenring, Daniel et al.
Unknown Host Publication. Vol. 16 American College of Cardiology, 2016.

Research output: Chapter in Book/Report/Conference proceeding › Conference contribution › peer-review

TY - GEN

T1 - Improving The Diagnosis Of Acute Myocardial Infarction By Deriving Epicardial Potentials From The Body Surface Potential Map Using Inverse Electrocardiography And An Individualized Torso Model

AU - Daly, Michael

AU - Finlay, Dewar

AU - Guldenring, Daniel

AU - Bond, Raymond

AU - McCann, Aaron

AU - Scott, Peter

AU - Adgey, Jennifer

AU - Harbinson, Mark

PY - 2016/4/5

Y1 - 2016/4/5

N2 - Epicardial potentials (EP) derived from the body surface potential map (BSPM) improve acute myocardial infarction (AMI) diagnosis. In this study, we compared EP derived from the 80-lead BSPM using a standard thoracic volume conductor model (TVCM) with those derived using a patient-specific torso model (PSTM) based on body mass index (BMI). Patients presenting to ED between August 2009 and August 2011 with acute ischaemic-type chest pain at rest were enrolled. At first medical contact, 12-lead ECG and BSPM were recorded. BMI for each patient was calculated. Cardiac troponin-T (cTnT) was sampled 12h after symptom onset. Patients were excluded from analysis if they had any electrocardiographic confounders to interpretation of the ST-segment. A cardiologist assessed the 12-lead ECG for STEMI by Minnesota criteria and BSPM. BSPM ST-elevation (STE) was ≥0.2mV in anterior, ≥0.1mV in lateral, inferior, RV or high right anterior and ≥0.05mV in posterior territories. To derive EP, the BSPM data were interpolated to yield values at 352-nodes of a Dalhousie torso. Using an inverse solution based on the boundary element method, EP at 98 cardiac nodes positioned within a standard TVCM were derived. The TVCM was then scaled to produce a PSTM, using a model developed from CT in 48 patients of varying BMI, and EP re-calculated. EP ≥0.3mV defined STE. A cardiologist blinded to both the 12-lead ECG and BSPM interpreted the EP map. AMI was defined as cTnT ≥0.1µg/L. Enrolled were 400 patients (age 62 ± 13 yrs; 57% male): 80 patients had exclusion criteria. Of the remaining 320 patients, BMI was 27.8 ± 5.6kg m-2. Of these, 180 (56%) had AMI. Overall, 132 had Minnesota STEMI on ECG (sensitivity 65%, sensitivity 89%) and 160 had BSPM STE (sensitivity 81%, specificity 90%). EP STE occurred in 165 patients using TVCM (sensitivity 88%, specificity 95%, p

AB - Epicardial potentials (EP) derived from the body surface potential map (BSPM) improve acute myocardial infarction (AMI) diagnosis. In this study, we compared EP derived from the 80-lead BSPM using a standard thoracic volume conductor model (TVCM) with those derived using a patient-specific torso model (PSTM) based on body mass index (BMI). Patients presenting to ED between August 2009 and August 2011 with acute ischaemic-type chest pain at rest were enrolled. At first medical contact, 12-lead ECG and BSPM were recorded. BMI for each patient was calculated. Cardiac troponin-T (cTnT) was sampled 12h after symptom onset. Patients were excluded from analysis if they had any electrocardiographic confounders to interpretation of the ST-segment. A cardiologist assessed the 12-lead ECG for STEMI by Minnesota criteria and BSPM. BSPM ST-elevation (STE) was ≥0.2mV in anterior, ≥0.1mV in lateral, inferior, RV or high right anterior and ≥0.05mV in posterior territories. To derive EP, the BSPM data were interpolated to yield values at 352-nodes of a Dalhousie torso. Using an inverse solution based on the boundary element method, EP at 98 cardiac nodes positioned within a standard TVCM were derived. The TVCM was then scaled to produce a PSTM, using a model developed from CT in 48 patients of varying BMI, and EP re-calculated. EP ≥0.3mV defined STE. A cardiologist blinded to both the 12-lead ECG and BSPM interpreted the EP map. AMI was defined as cTnT ≥0.1µg/L. Enrolled were 400 patients (age 62 ± 13 yrs; 57% male): 80 patients had exclusion criteria. Of the remaining 320 patients, BMI was 27.8 ± 5.6kg m-2. Of these, 180 (56%) had AMI. Overall, 132 had Minnesota STEMI on ECG (sensitivity 65%, sensitivity 89%) and 160 had BSPM STE (sensitivity 81%, specificity 90%). EP STE occurred in 165 patients using TVCM (sensitivity 88%, specificity 95%, p

KW - cardiology

KW - electrocardiogram

KW - inverse electrocardiology

KW - body surface potential maps

KW - boundary element

KW - myocardial infarction

KW - heart

KW - STEMI

U2 - 10.1016/S0735-1097(16)30656-8

DO - 10.1016/S0735-1097(16)30656-8

M3 - Conference contribution

VL - 16

BT - Unknown Host Publication

PB - American College of Cardiology

T2 - American College of Cardiology

Y2 - 5 April 2016

ER -

Improving The Diagnosis Of Acute Myocardial Infarction By Deriving Epicardial Potentials From The Body Surface Potential Map Using Inverse Electrocardiography And An Individualized Torso Model

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