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ECG-Based Detection of Early Myocardial Ischemia in a Computational Model: Impact of Additional Electrodes, Optimal
Axel Loewe1, Walther H W Schulze1, Yuan Jiang2
1Karlsruhe Institute of Technology (KIT), Institute of Biomedical Engineering, Kaiserstraße 12, 76128 Karlsruhe, Germany.
Insights
Detecting myocardial ischemia without ST elevation is challenging. This study shows that optimized ECG electrode placement and body surface potential mapping can improve detection rates, offering better diagnostic capabilities for early cardiac ischemia.
Area of Science:
- Cardiology
- Biomedical Engineering
- Computational Medicine
Background:
- Immediate diagnosis of myocardial ischemia is crucial for timely treatment during chest pain.
- Standard electrocardiogram (ECG) has limited diagnostic capability for ischemia without ST elevation.
Purpose of the Study:
- To investigate the potential of different electrode setups for detecting early myocardial ischemia.
- To assess if optimized electrode placement or right-sided leads improve standard 12-lead ECG sensitivity.
Main Methods:
- A computational simulation study was performed for 765 ischemia scenarios in the left ventricle.
- Evaluated standard 3-channel and 12-lead ECG, body surface potential maps (BSPMs), and modified electrode configurations.
- Introduced K point deviation as an alternative feature for ST deviation analysis.
Main Results:
- Optimized single electrode placement and BSPMs improved ischemia detection rates by 2-11% compared to standard 12-lead ECG.
- Right-sided Wilson leads showed negligible improvement in detection sensitivity.
- The K point deviation feature increased the 12-lead ECG detection rate by 7%.
Conclusions:
- Optimized electrode configurations and BSPMs show promise for enhancing early ischemia detection, especially in non-ST elevation events.
- The K point deviation offers a valuable alternative metric for analyzing ST deviations in ECG.
- Further research may integrate these methods for improved cardiac diagnostics.
Abstract:
In case of chest pain, immediate diagnosis of myocardial ischemia is required to respond with an appropriate treatment. The diagnostic capability of the electrocardiogram (ECG), however, is strongly limited for ischemic events that do not lead to ST elevation. This computational study investigates the potential of different electrode setups in detecting early ischemia at 10 minutes after onset: standard 3-channel and 12-lead ECG as well as body surface potential maps (BSPMs). Further, it was assessed if an additional ECG electrode with optimized position or the right-sided Wilson leads can improve sensitivity of the standard 12-lead ECG. To this end, a simulation study was performed for 765 different locations and sizes of ischemia in the left ventricle. Improvements by adding a single, subject specifically optimized electrode were similar to those of the BSPM: 2-11% increased detection rate depending on the desired specificity. Adding right-sided Wilson leads had negligible effect. Absence of ST deviation could not be related to specific locations of the ischemic region or its transmurality. As alternative to the ST time integral as a feature of ST deviation, the K point deviation was introduced: the baseline deviation at the minimum of the ST-segment envelope signal, which increased 12-lead detection rate by 7% for a reasonable threshold.
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