The use of calculated epicardial potentials improves significantly the sensitivity of a diagnostic algorithm in the detection of acute myocardial infarction

C Navaro, C Owens, J Riddell, A McClelland, JMCC Anderson, OJ Escalona, C Turner, JJA Adgey

Research output: Contribution to journalArticle

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Abstract

Inverse electrocardiography can calculate epicardial potentials (EP) from body surface potentials (BSP) taking into account a thoracic volume conductor model (TVCM). Previous studies have shown that a tailored TVCM is superior to a general TVCM in calculating EP. However, construction of a tailored TVCM for a patient in an acute clinical setting is impractical. In this study we used a general TVCM in our EP calculations to determine whether this improves detection of acute myocardial infarction (AMI) using a diagnostic algorithm. BSP were derived from the 80-lead body surface map (BSM). Consecutive patients (n=379) with ischemic type chest pain were recruited. The BSM and a 12-lead electrocardiogram (ECG) were recorded at initial presentation and creatine kinase (CK) and/or CK-MB were measured initially, 12 and 24 hours postsymptom onset. A physician interpreted the 12-lead electrocardiogram and documented ST elevation if present. AMI was defined by the World Health Organization (WHO) criteria. The diagnostic algorithm result for each patient using BSP and calculated EP were documented. AMI occurred in 171 patients. The diagnostic algorithm using BSP identified 106 of these as ST elevation AMI (STEMI) (sensitivity 62%, specificity 80%). The same algorithm using EP identified 133 as STEMI (sensitivity 78%, specificity 80%). Calculated EP improved the algorithm's diagnostic sensitivity by a factor of 1.25 (P<.001) with no significant difference in specificity. Calculated EP using a general TVCM significantly improves the sensitivity of a diagnostic algorithm based on BSP in detection of AMI with no significant loss in specificity.
LanguageEnglish
Pages127-132
JournalJournal of Electrocardiology
Volume36 Sup
Publication statusPublished - 2003

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Thorax
Myocardial Infarction
Electrocardiography
Sensitivity and Specificity
MB Form Creatine Kinase
Creatine Kinase
Chest Pain
Physicians
Lead

Keywords

  • Algorithms
  • Body Surface Potential Mapping
  • Electrocardiography: methods
  • Humans
  • Models
  • Cardiovascular
  • Myocardial Infarction: diagnosis
  • Pericardium: physiology
  • Sensitivity and Specificity

Cite this

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title = "The use of calculated epicardial potentials improves significantly the sensitivity of a diagnostic algorithm in the detection of acute myocardial infarction",
abstract = "Inverse electrocardiography can calculate epicardial potentials (EP) from body surface potentials (BSP) taking into account a thoracic volume conductor model (TVCM). Previous studies have shown that a tailored TVCM is superior to a general TVCM in calculating EP. However, construction of a tailored TVCM for a patient in an acute clinical setting is impractical. In this study we used a general TVCM in our EP calculations to determine whether this improves detection of acute myocardial infarction (AMI) using a diagnostic algorithm. BSP were derived from the 80-lead body surface map (BSM). Consecutive patients (n=379) with ischemic type chest pain were recruited. The BSM and a 12-lead electrocardiogram (ECG) were recorded at initial presentation and creatine kinase (CK) and/or CK-MB were measured initially, 12 and 24 hours postsymptom onset. A physician interpreted the 12-lead electrocardiogram and documented ST elevation if present. AMI was defined by the World Health Organization (WHO) criteria. The diagnostic algorithm result for each patient using BSP and calculated EP were documented. AMI occurred in 171 patients. The diagnostic algorithm using BSP identified 106 of these as ST elevation AMI (STEMI) (sensitivity 62{\%}, specificity 80{\%}). The same algorithm using EP identified 133 as STEMI (sensitivity 78{\%}, specificity 80{\%}). Calculated EP improved the algorithm's diagnostic sensitivity by a factor of 1.25 (P<.001) with no significant difference in specificity. Calculated EP using a general TVCM significantly improves the sensitivity of a diagnostic algorithm based on BSP in detection of AMI with no significant loss in specificity.",
keywords = "Algorithms, Body Surface Potential Mapping, Electrocardiography: methods, Humans, Models, Cardiovascular, Myocardial Infarction: diagnosis, Pericardium: physiology, Sensitivity and Specificity",
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The use of calculated epicardial potentials improves significantly the sensitivity of a diagnostic algorithm in the detection of acute myocardial infarction. / Navaro, C; Owens, C; Riddell, J; McClelland, A; Anderson, JMCC; Escalona, OJ; Turner, C; Adgey, JJA.

In: Journal of Electrocardiology, Vol. 36 Sup, 2003, p. 127-132.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The use of calculated epicardial potentials improves significantly the sensitivity of a diagnostic algorithm in the detection of acute myocardial infarction

AU - Navaro, C

AU - Owens, C

AU - Riddell, J

AU - McClelland, A

AU - Anderson, JMCC

AU - Escalona, OJ

AU - Turner, C

AU - Adgey, JJA

N1 - LR: 20091111RX: 850816 (on Jul 22, 2011)

PY - 2003

Y1 - 2003

N2 - Inverse electrocardiography can calculate epicardial potentials (EP) from body surface potentials (BSP) taking into account a thoracic volume conductor model (TVCM). Previous studies have shown that a tailored TVCM is superior to a general TVCM in calculating EP. However, construction of a tailored TVCM for a patient in an acute clinical setting is impractical. In this study we used a general TVCM in our EP calculations to determine whether this improves detection of acute myocardial infarction (AMI) using a diagnostic algorithm. BSP were derived from the 80-lead body surface map (BSM). Consecutive patients (n=379) with ischemic type chest pain were recruited. The BSM and a 12-lead electrocardiogram (ECG) were recorded at initial presentation and creatine kinase (CK) and/or CK-MB were measured initially, 12 and 24 hours postsymptom onset. A physician interpreted the 12-lead electrocardiogram and documented ST elevation if present. AMI was defined by the World Health Organization (WHO) criteria. The diagnostic algorithm result for each patient using BSP and calculated EP were documented. AMI occurred in 171 patients. The diagnostic algorithm using BSP identified 106 of these as ST elevation AMI (STEMI) (sensitivity 62%, specificity 80%). The same algorithm using EP identified 133 as STEMI (sensitivity 78%, specificity 80%). Calculated EP improved the algorithm's diagnostic sensitivity by a factor of 1.25 (P<.001) with no significant difference in specificity. Calculated EP using a general TVCM significantly improves the sensitivity of a diagnostic algorithm based on BSP in detection of AMI with no significant loss in specificity.

AB - Inverse electrocardiography can calculate epicardial potentials (EP) from body surface potentials (BSP) taking into account a thoracic volume conductor model (TVCM). Previous studies have shown that a tailored TVCM is superior to a general TVCM in calculating EP. However, construction of a tailored TVCM for a patient in an acute clinical setting is impractical. In this study we used a general TVCM in our EP calculations to determine whether this improves detection of acute myocardial infarction (AMI) using a diagnostic algorithm. BSP were derived from the 80-lead body surface map (BSM). Consecutive patients (n=379) with ischemic type chest pain were recruited. The BSM and a 12-lead electrocardiogram (ECG) were recorded at initial presentation and creatine kinase (CK) and/or CK-MB were measured initially, 12 and 24 hours postsymptom onset. A physician interpreted the 12-lead electrocardiogram and documented ST elevation if present. AMI was defined by the World Health Organization (WHO) criteria. The diagnostic algorithm result for each patient using BSP and calculated EP were documented. AMI occurred in 171 patients. The diagnostic algorithm using BSP identified 106 of these as ST elevation AMI (STEMI) (sensitivity 62%, specificity 80%). The same algorithm using EP identified 133 as STEMI (sensitivity 78%, specificity 80%). Calculated EP improved the algorithm's diagnostic sensitivity by a factor of 1.25 (P<.001) with no significant difference in specificity. Calculated EP using a general TVCM significantly improves the sensitivity of a diagnostic algorithm based on BSP in detection of AMI with no significant loss in specificity.

KW - Algorithms

KW - Body Surface Potential Mapping

KW - Electrocardiography: methods

KW - Humans

KW - Models

KW - Cardiovascular

KW - Myocardial Infarction: diagnosis

KW - Pericardium: physiology

KW - Sensitivity and Specificity

M3 - Article

VL - 36 Sup

SP - 127

EP - 132

JO - Journal of Electrocardiology

T2 - Journal of Electrocardiology

JF - Journal of Electrocardiology

SN - 0022-0736

ER -