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Patient Directed Recording of a Bipolar Three-Lead Electrocardiogram using a Smartwatch with ECG Function
Published on: December 11, 2019
Multichannel Electrocardiograms Obtained by a Smartwatch for the Diagnosis of ST-Segment Changes
Carmen Anna Maria Spaccarotella1,2, Alberto Polimeni1,2, Serena Migliarino1
1Division of Cardiology, Magna Graecia University, Catanzaro, Italy.
Insights
A smartwatch ECG showed high agreement with standard 12-lead ECG for detecting acute coronary syndromes. This wearable technology offers a feasible and accurate method for diagnosing ST-segment changes, improving patient outcomes.
Area of Science:
- Cardiology
- Medical Devices
- Digital Health
Background:
- Acute coronary syndromes (ACS) are a leading global cause of mortality.
- Timely and accurate diagnosis of ACS is critical for effective intervention and improved patient prognosis.
Purpose of the Study:
- To assess the feasibility and accuracy of a smartwatch in recording multiple electrocardiographic (ECG) leads.
- To compare smartwatch ECG detection of ST-segment changes in ACS with standard 12-lead ECG.
Main Methods:
- A commercially available smartwatch was used to obtain 9-lead ECGs from 100 participants (including ACS patients and healthy individuals).
- Smartwatch ECGs were compared against simultaneous 12-lead ECG recordings.
- Concordance was analyzed using Cohen κ coefficient and Bland-Altman analysis.
Main Results:
- High agreement was observed between smartwatch and standard ECG for normal ECGs (κ=0.90), ST-segment elevation (κ=0.88), and non-ST-segment elevation (κ=0.85).
- Smartwatch ECG demonstrated high sensitivity and specificity for diagnosing normal ECGs, ST elevation, and NSTE ECG alterations.
- Bland-Altman analysis confirmed agreement in detecting ST-segment amplitude.
Conclusions:
- Multichannel smartwatch ECG technology shows significant agreement with standard ECG for identifying ST-segment changes in ACS.
- Smartwatches represent a promising tool for the remote and accessible monitoring of cardiac conditions.
Importance:
Acute coronary syndromes are the leading cause of death worldwide and the leading cause of disease burden in high-income countries. Quick and accurate diagnosis of acute coronary syndromes is essential to avoid fatal events, for timely intervention, and to improve the prognosis.
Objective:
To prospectively investigate the feasibility and accuracy of a smartwatch in recording multiple electrocardiographic (ECG) leads and detecting ST-segment changes associated with acute coronary syndromes compared with a standard 12-lead ECG.
Design, Setting, And Participants:
A commercially available smartwatch was used in 100 participants to obtain multiple-channel ECGs. The study was conducted from April 19, 2019, to January 23, 2020. Fifty-four patients with ST elevation myocardial infarction, 27 patients with non-ST elevation myocardial infarction, and 19 healthy individuals were included in the study. The watch was placed in different body positions to obtain 9 bipolar ECG tracings (corresponding to Einthoven leads I, II, and III and precordial leads V1-V6) that were compared with a simultaneous standard 12-lead ECG.
Main Outcomes And Measures:
The concordance among the results of the smartwatch and standard ECG recordings was assessed using the Cohen κ coefficient and Bland-Altman analysis.
Results:
Of the 100 participants in the study, 67 were men (67%); mean (SD) age was 61 (16) years. Agreement was found between the smartwatch and standard ECG for the identification of a normal ECG (Cohen κ coefficient, 0.90; 95% CI, 0.78-1.00), ST-segment elevation changes (Cohen κ coefficient, 0.88; 95% CI, 0.78-0.97), and non-ST-segment elevation changes (Cohen κ coefficient, 0.85; 95% CI, 0.74-0.96). In addition, the Bland-Altman analysis demonstrated agreement between the smartwatch and standard ECG to detect the amplitude of ST-segment changes (bias, -0.003; SD, 0.18; lower limit, -0.36; and upper limit, 0.36). Use of the smartwatch ECG for the diagnosis of normal ECG showed a sensitivity of 84% (95% CI, 60%-97%) and specificity of 100% (95% CI, 95%-100%); for ST elevation, sensitivity was 93% (95% CI, 82%-99%) and specificity was 95% (95% CI, 85%-99%); and for NSTE ECG alterations, sensitivity was 94% (95% CI, 81%-99%) and specificity was 92% (95% CI, 83%-97%).
Conclusions And Relevance:
The findings of this study suggest agreement between the multichannel smartwatch ECG and standard ECG for the identification of ST-segment changes in patients with acute coronary syndromes.
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