ST depression only on the initial 12-lead ECG: early diagnosis of acute myocardial infarction
I B Menown1, J Allen, J M Anderson
1Regional Medical Cardiology Centre, Royal Victoria Hospital, Belfast, Northern Ireland, UK.
Insights
Body surface mapping shows improved early detection of acute myocardial infarction compared to the 12-lead electrocardiogram (ECG) in patients with ST depression. This advanced mapping technique offers higher sensitivity for diagnosing heart attacks.
Area of Science:
- Cardiology
- Medical Diagnostics
- Biomedical Engineering
Background:
- Acute myocardial infarction (AMI) diagnosis relies on electrocardiograms (ECGs).
- Patients presenting with ST depression on a 12-lead ECG pose a diagnostic challenge for early AMI detection.
- Novel diagnostic tools are needed to improve accuracy in these cases.
Purpose of the Study:
- To compare the diagnostic performance of 12-lead ECG versus 80-lead body surface mapping (BSM) for early AMI detection.
- To evaluate diagnostic models derived from 12-lead ECG and BSM in patients with ST depression.
Main Methods:
- Fifty-four patients with chest pain and ST depression underwent 12-lead ECG and 80-lead BSM.
- Univariate and multivariate prediction models for AMI were developed using training sets.
- Models were prospectively validated on independent datasets.
Main Results:
- The optimal 12-lead ECG multivariate model showed low sensitivity (38%) but good specificity (81%) for AMI.
- The optimal BSM multivariate model achieved high sensitivity (88%) and good specificity (75%) for AMI.
- BSM improved AMI prediction beyond conventional 12-lead ECG analysis.
Conclusions:
- Body surface mapping demonstrates superior diagnostic ability compared to the 12-lead ECG for early AMI detection in specific patient cohorts.
- BSM offers a promising advancement in diagnosing acute myocardial infarction, particularly when ST depression is the primary ECG finding.
Aims:
To compare the diagnostic ability of the 12-lead ECG with body surface mapping for early detection of acute myocardial infarction in patients presenting with ST depression only on the 12-lead ECG.
Methods And Results:
Fifty-four consecutive patients with chest pain <24 h and ST depression were recruited. A 12-lead ECG and 80-lead body surface map were recorded at presentation from which univariate and multivariate prediction models of acute myocardial infarction were developed. Patients were randomly divided into a training-set and a validation-set. Acute myocardial infarction occurred in 16/30 training-set and 8/24 validation-set patients. Univariate prediction of acute myocardial infarction by the 12-lead ECG, based on the depth or numbers of leads with ST depression, was not improved by assessment of ST elevation outside the conventional 12 leads using body surface mapping. The optimum multivariate 12-lead ECG model developed in training-set patients (six ST depression variables) had poor sensitivity (38%) although good specificity (81%) for acute myocardial infarction when tested prospectively in validation-set patients. In contrast, the optimum body surface mapping model developed in training-set patients (three isointegral or isopotential variables) achieved high sensitivity (88%) whilst maintaining good specificity (75%) for acute myocardial infarction when tested prospectively in validation-set patients.
Conclusion:
Body surface mapping, when compared with the 12-lead ECG, may improve the early diagnosis of acute myocardial infarction in patients presenting with chest pain and ST depression only on the 12-lead ECG.
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