Feasibility of Resting Multielectrode Electrocardiogram for Detecting Coronary Artery Disease

Myocardial ischemia can cause repolarization heterogeneity, manifesting as variations in QT interval; we hypothesized that repolarization heterogeneity could help identify patients with coronary artery disease (CAD). We tested this hypothesis by measuring repolarization heterogeneity with a newly developed multielectrode electrocardiogram (MECG) system, which uses 28 electrodes to increase the spatial resolution of body surface electrical activity.

Male patients admitted for coronary angiography were enrolled. Eighty-five patients were included in the training dataset, and 42 in the validation dataset. QTc heterogeneity indices including QTc dispersion (QTD) and smoothness index of QTc (SI-QTc) were derived from MECG signals. Sixty and 32 patients in the training and validation datasets, respectively, were found to have significant coronary stenosis. The SI-QTc (12.79 ± 4.29 vs. 9.22 ± 2.40 ms, p = 0.0004) and QTD (92.12 ± 34.31 vs. 67.2 ± 19.11 ms, p = 0.0004) of the patients in the training dataset were significantly higher in the CAD patients. The areas under the curve of SI-QTc and QTD in the training dataset were 0.7437 and 0.7433, respectively, for detecting CAD. With cutoff values of SI-QTc ≥ 9.95 ms and QTc dispersion ≥ 69 ms, the sensitivity and specificity for diagnosing CAD were 71.9% and 80.0%, respectively, in the validation dataset.

Resting MECG is a promising noninvasive tool for CAD diagnosis, with sensitivity and specificity comparable to those of the exercise electrocardiography test.