PMID- 27662776
OWN - NLM
STAT- MEDLINE
DCOM- 20171129
LR  - 20191210
IS  - 1532-8430 (Electronic)
IS  - 0022-0736 (Linking)
VI  - 49
IP  - 6
DP  - 2016 Nov-Dec
TI  - Validation of the vessel-specific leads (VSLs) for detection of acute ischemia on 
      a dataset with non-ischemic ST-segment deviation.
PG  - 800-806
LID - S0022-0736(16)30163-7 [pii]
LID - 10.1016/j.jelectrocard.2016.08.004 [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 acute 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). To further validate the method, we evaluated the SP 
      performance using a dataset with non-ischemic ST-segment changes. METHODS: 
      12-lead ECGs of 100 patients (75 males/25 females, age range 12-83years, average 
      age 52years) were retrieved from a centralized ECG management system at Skane 
      University Hospital, Lund, Sweden. These ECGs were chosen to represent five 
      subgroups with various causes of pathological ST deviation, other than acute 
      coronary occlusion: a) ventricular preexcitation (n=12), b) acute pericarditis 
      (n=26), c) early repolarization syndrome (ERS) (n=14), d) left ventricular 
      hypertrophy (LVH) with "strain" (n=26), and e) left bundle branch block (LBBB) 
      (n=22). ECGs with inadequate signal quality, heart rate exceeding 120bpm and/or 
      atrial flutter were not selected for this study population. Both STEMI criteria 
      and VSLs criteria with and without a new augmented LVH-specific derived lead were 
      tested. SP, calculated for each subgroup and combined, was used as the 
      performance measure for comparison. RESULTS: SP test results for the STEMI 
      criteria vs. the VSLs method without the augmented LVH lead were 100% vs. 92%, 4% 
      vs. 88%, 29% vs. 100%, 100% vs. 77%, and 64% vs. 68% for the five subgroups with 
      preexcitation, pericarditis, ERS, LVH, and LBBB, respectively. For the whole 
      group, SP was 57% for the STEMI criteria and 83% for the VSLs criteria; this 
      improvement was statistically significant (p<0.001). With the augmented LVH lead, 
      SP for the VSLs improved from 77% to 96% for the LVH subgroup and SP for the 
      other subgroups remained unchanged. For the whole study group, SP improved from 
      83% to 88%. CONCLUSION: Based on these results, we conclude that the VSLs 
      criteria are not only more sensitive in detecting acute ischemia but also more 
      specific in recognizing patients with non-ischemic ST deviation than the existing 
      STEMI criteria. This finding needs to be further corroborated on a larger patient 
      population with AMI prevalence typical of the population presenting to the 
      emergency room.
CI  - Copyright (c) 2016 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 - Pahlm, Olle
AU  - Pahlm O
AD  - University Hospital, Lund, Sweden.
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  - CIHR/Canada
PT  - Evaluation Study
PT  - Journal Article
PT  - Validation Study
DEP - 20160818
PL  - United States
TA  - J Electrocardiol
JT  - Journal of electrocardiology
JID - 0153605
SB  - IM
MH  - Acute Disease
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - *Algorithms
MH  - Child
MH  - Diagnosis, Computer-Assisted/*methods
MH  - Electrocardiography/*methods
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardial Ischemia/*complications/*diagnosis
MH  - Reproducibility of Results
MH  - ST Elevation Myocardial Infarction/*complications/*diagnosis
MH  - Sensitivity and Specificity
MH  - Young Adult
OTO - NOTNLM
OT  - Acute ischemia detection
OT  - Electrocardiographic monitoring
OT  - Non-ischemic ST-segment deviation
OT  - STEMI
OT  - Vessel-specific leads
EDAT- 2016/09/25 06:00
MHDA- 2017/12/01 06:00
CRDT- 2016/09/25 06:00
PHST- 2016/05/22 00:00 [received]
PHST- 2016/09/25 06:00 [pubmed]
PHST- 2017/12/01 06:00 [medline]
PHST- 2016/09/25 06:00 [entrez]
AID - S0022-0736(16)30163-7 [pii]
AID - 10.1016/j.jelectrocard.2016.08.004 [doi]
PST - ppublish
SO  - J Electrocardiol. 2016 Nov-Dec;49(6):800-806. doi: 
      10.1016/j.jelectrocard.2016.08.004. Epub 2016 Aug 18.