PMID- 26410198
OWN - NLM
STAT- MEDLINE
DCOM- 20160808
LR  - 20191210
IS  - 1532-8430 (Electronic)
IS  - 0022-0736 (Linking)
VI  - 48
IP  - 6
DP  - 2015 Nov-Dec
TI  - Validation of improved vessel-specific leads (VSLs) for detecting acute 
      myocardial ischemia.
PG  - 1032-9
LID - S0022-0736(15)00290-3 [pii]
LID - 10.1016/j.jelectrocard.2015.08.033 [doi]
AB  - BACKGROUND: Existing criteria recommended by ACC/ESC for identifying patients 
      with ST elevation myocardial infarction (STEMI) from the 12-lead ECG perform with 
      high specificity (SP), but low sensitivity (SE). In our previous studies, we 
      found that the SE of ischemia detection can be markedly improved without any loss 
      of SP by calculating, from the 12-lead ECG, ST deviation in 3 "optimal" 
      vessel-specific leads (VSLs). Our original VSLs, based on DeltaST body-surface 
      potential maps (BSPMs), have been modified by using the more appropriate J-point 
      BSPMs at peak ischemia (without subtraction of pre-occlusion distributions). The 
      aim of the present study was to compare the performance of these new VSLs with 
      that achieved by the STEMI criteria used in current practice. METHODS: Two 
      independent datasets of 12-lead ECGs were used: the STAFF III dataset acquired 
      during ischemic episodes caused by balloon inflation in LAD (n=35), RCA (n=47), 
      and LCx (n=17) coronary arteries, and the Glasgow dataset comprising admission 
      12-lead ECGs of 116 patients who were hospitalized for chest pain and underwent 
      contrast-enhanced cardiac MRI that confirmed AMI in 58 patients (50%). RESULTS: 
      We found that, in the STAFF III dataset, the detection of ischemic state by the 
      STEMI criteria attained SE/SP of 60/97%, whereas SE/SP values of VSLs were 
      72/98%. In the Glasgow dataset, STEMI criteria yielded SE/SP of 43/98%, whereas 
      the VSLs improved SE/SP to 60/98%. The most significant increase in diagnostic 
      performance appeared in patients with LCx coronary artery occlusion: in STAFF III 
      data (n=17) SE achieved by STEMI criteria was improved by the VSLs from 35% to 
      71%; in Glasgow data (n=12) SE of 31% achieved by STEMI criteria was improved by 
      the VSLs to 69%. CONCLUSION: In our study population, existing ACC/ESC STEMI 
      criteria complemented by the new VSLs yielded much improved sensitivity of 
      ischemia detection without any detrimental effect on specificity. This finding 
      needs to be corroborated on a larger chest-pain patient population with typical 
      prevalence of acute ischemia presented to the emergency rooms.
CI  - Copyright (c) 2015 Elsevier Inc. All rights reserved.
FAU - Wang, John J
AU  - Wang JJ
AD  - Philips Healthcare, Andover, MA, USA. Electronic address: 
      john.j.wang@philips.com.
FAU - Title, Lawrence M
AU  - Title LM
AD  - Dalhousie University, Halifax, NS, Canada.
FAU - Martin, Thomas N
AU  - Martin TN
AD  - University Medical Centre, Dundee, Scotland, UK.
FAU - Wagner, Galen S
AU  - Wagner GS
AD  - Duke University Medical Center, Durham, NC, USA.
FAU - Warren, James W
AU  - Warren JW
AD  - Dalhousie University, Halifax, NS, Canada.
FAU - Horacek, B Milan
AU  - Horacek BM
AD  - Dalhousie University, Halifax, NS, Canada.
FAU - Sapp, John L
AU  - Sapp JL
AD  - Dalhousie University, Halifax, NS, Canada.
LA  - eng
GR  - Canadian Institutes of Health Research/Canada
PT  - Evaluation Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Validation Study
DEP - 20150821
PL  - United States
TA  - J Electrocardiol
JT  - Journal of electrocardiology
JID - 0153605
SB  - IM
MH  - Acute Disease
MH  - *Algorithms
MH  - Body Surface Potential Mapping/instrumentation/*methods
MH  - Diagnosis, Computer-Assisted/*methods
MH  - Early Diagnosis
MH  - Humans
MH  - Myocardial Ischemia/*diagnosis
MH  - Reproducibility of Results
MH  - Sensitivity and Specificity
OTO - NOTNLM
OT  - Acute ischemia detection
OT  - Electrocardiographic monitoring
OT  - STEMI
OT  - Vessel-specific leads
EDAT- 2015/09/28 06:00
MHDA- 2016/08/09 06:00
CRDT- 2015/09/28 06:00
PHST- 2015/06/09 00:00 [received]
PHST- 2015/08/09 00:00 [revised]
PHST- 2015/09/28 06:00 [entrez]
PHST- 2015/09/28 06:00 [pubmed]
PHST- 2016/08/09 06:00 [medline]
AID - S0022-0736(15)00290-3 [pii]
AID - 10.1016/j.jelectrocard.2015.08.033 [doi]
PST - ppublish
SO  - J Electrocardiol. 2015 Nov-Dec;48(6):1032-9. doi: 
      10.1016/j.jelectrocard.2015.08.033. Epub 2015 Aug 21.