Optimal ECG Lead System for Exercise Assessment of Ischemic Heart Disease

Area of Science:

• Cardiology
• Medical Diagnostics
• Biomedical Engineering

Background:

• The diagnostic accuracy of conventional 12-lead electrocardiogram (ECG) exercise tests for ischemic heart disease (IHD) is limited.
• There is a need for more efficient diagnostic methods for IHD using fewer ECG leads.

Purpose of the Study:

• To develop and evaluate a novel method for diagnosing IHD using a reduced number of optimized ECG leads.
• To compare the diagnostic efficiency of this new method against the standard 12-lead exercise ECG test.

Main Methods:

• A high-resolution 67-lead ECG was recorded from 43 patients at rest and during exercise.
• Diagnostic value was assessed for ST segment depression (ΔST60) and T-wave morphology changes (δT) in optimized lead configurations.
• Sensitivity and specificity were calculated for optimized lead sets and compared to the standard 12-lead ECG.

Main Results:

• Optimized ECG lead configurations demonstrated higher diagnostic value for both ΔST60 and δT compared to the standard 12-lead ECG.
• The best performance was achieved with δT from 6 ECG electrode locations, yielding 70% sensitivity and 69% specificity.
• Standard exercise ECG showed 63% sensitivity and 62% specificity.

Conclusions:

• A diagnostic method utilizing a small number of optimized ECG leads, particularly focusing on T-wave morphology changes, can enhance IHD diagnosis.
• This approach offers superior diagnostic efficiency compared to conventional exercise ECG.
• The reduced lead requirement facilitates straightforward hardware implementation for clinical use.