Optimal ECG Lead System for Exercise Assessment of Ischemic Heart Disease
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ORIGINAL ARTICLE
Optimal ECG Lead System for Exercise Assessment of Ischemic Heart Disease Michał Kania 1 & Roman Maniewski 1 & Rajmund Zaczek 2 & Małgorzata Kobylecka 3 & Heriberto Zavala-Fernandez 1 & Leszek Królicki 3 & Grzegorz Opolski 2 Received: 20 September 2019 / Accepted: 10 December 2019 # Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract The diagnostic value of an ECG exercise test in diagnosis of ischemic heart disease (IHD) is limited. We investigated whether it is possible to develop a method for diagnosis of IHD which uses a low number of optimal ECG leads and has a higher diagnostic efficiency than conventional exercise ECG. This study was carried out on 43 patients. The 67-lead high-resolution ECG was recorded at rest and during exercise. The diagnostic value of ST segment depression (ΔST60) and T-wave morphology change (δT) determined in optimized ECG lead configurations was higher than for the standard 12-lead ECG. The best results were obtained for δT determined from 6 ECG electrode locations where sensitivity and specificity were 70% and 69% whereas for the standard exercise ECG were 63% and 62%, respectively. The small number of ECG leads used allows for easy hardware implementation of the methods for use in clinical settings. Keywords Multi-lead high-resolution ECG . Ischemic heart disease . Exercise test . Optimal ECG leads system
Abbreviations IHD Ischemic heart disease Se Sensitivity Sp Specificity CA Coronary angiography SPECT Single photon emission computed tomography BSPM Body surface potential mapping STEMI ST-Elevation myocardial infarction H R High-resolution body surface potential mapping BSPM CT Computed tomography Associate Editor Marat Fudim oversaw the review of this article * Michał Kania [email protected] 1
Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Trojdena 4, 02-109 Warsaw, Poland
2
Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
3
Department of Nuclear Medicine, Medical University of Warsaw, Warsaw, Poland
CAD WCT DI SD MI BMI LVEF
Coronary artery disease Wilson Central Terminal reference signal Discriminant Index Standard deviation Myocardial infarction Body mass index Left ventricular ejection fraction
Introduction A 12-lead exercise ECG is widely used in the early diagnosis of ischemic heart disease (IHD). Unfortunately, sensitivity (Se) and specificity (Sp) in detecting IHD using this noninvasive method are limited [1]. More accurate methods including coronary artery imaging (coronary angiography— CA), myocardial perfusion imaging by single photon emission computed tomography (SPECT), stress echocardiography, stress cardiac magnetic resonance, or positron emission tomography [2] are not readily available for all symptomatic patients. A body surface potential mapping (BSPM) is a noninvasive diagnostic method. The superiority of BSPM over the standard ECG has been well reported [3, 4]. Our latest studies [5, 6] revealed the benefits of using high-resolution BSPM (H
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