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Maximal increase in sensitivity with minimal loss of specificity for diagnosis of acute coronary occlusion achieved by sequentially adding leads from the 24-lead electrocardiogram to the orderly sequenced 12-lead electrocardiogram

Perron, Annick; Lim, Tobin; Pahlm-Webb, Ulrika; Wagner, Galen S. and Pahlm, Olle LU (2007) In Journal of Electrocardiology 40(6). p.463-469
Abstract
Objectives: This study investigates whether sequential addition of inverted, (negative) leads from the 24-lead electrocardiogram (ECG) to the orderly sequenced 12-lead ECG would identify a number of leads with which the sensitivity for diagnosis of acute transmural ischemia is significantly increased with minimal loss of specificity. Background: Acute transmural ischemia due to thrombotic coronary occlusion typically progresses to infarction. Its recognition is based on currently accepted ST-elevation myocardial infarction (STEMI) criteria with suboptimal sensitivity, which could be potentially increased by consideration of the principle that each of the 12 ECG leads can be inverted to provide an additional lead with the opposite (180... (More)
Objectives: This study investigates whether sequential addition of inverted, (negative) leads from the 24-lead electrocardiogram (ECG) to the orderly sequenced 12-lead ECG would identify a number of leads with which the sensitivity for diagnosis of acute transmural ischemia is significantly increased with minimal loss of specificity. Background: Acute transmural ischemia due to thrombotic coronary occlusion typically progresses to infarction. Its recognition is based on currently accepted ST-elevation myocardial infarction (STEMI) criteria with suboptimal sensitivity, which could be potentially increased by consideration of the principle that each of the 12 ECG leads can be inverted to provide an additional lead with the opposite (180 degrees) orientation, generating a 24-lead ECG. Methods: The study population included 162 patients who underwent prolonged coronary occlusion during elective percutaneoas transluminal coronary angioplasty. Balloon occlusion was performed in the left anterior descending coronary artery (51 patients), in the right coronary artery (67 patients), or in the left circumflex coronary artery (44 patients). To be classified as indicative of the epicardial injury current of acute ischemia, the ECGs had to fulfill either the criteria of a consensus document from the American College of Cardiology or the European Society of Cardiology or thresholds for the inverted leads based on a population study from Scotland. Results: The addition of -V1, -V2, -V3, -aVL, -I, aVR, and -III increased sensitivity from 61% to 78% (P <= .01) and decreased specificity from 96% to 93% (P = .06). Conclusions: Addition of 7 leads from the 24-lead ECG, thus creating a 19-lead ECG, was found optimal for attaining high sensitivity while retaining high specificity when compared with the performance of the standard 12-lead ECG. (C) 2007 Elsevier Inc. All rights reserved. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
PTCA, sensitivity, specificity, acute myocardial infarction, 12-lead ECG, acute coronary syndromes
in
Journal of Electrocardiology
volume
40
issue
6
pages
463 - 469
publisher
Elsevier
external identifiers
  • wos:000251258500001
  • scopus:35748932025
ISSN
1532-8430
DOI
10.1016/j.jelectrocard.2007.07.002
language
English
LU publication?
yes
id
7df13397-74b4-4739-945e-7ceec3ce62bc (old id 968839)
date added to LUP
2008-01-30 07:57:55
date last changed
2017-10-22 03:33:00
@article{7df13397-74b4-4739-945e-7ceec3ce62bc,
  abstract     = {Objectives: This study investigates whether sequential addition of inverted, (negative) leads from the 24-lead electrocardiogram (ECG) to the orderly sequenced 12-lead ECG would identify a number of leads with which the sensitivity for diagnosis of acute transmural ischemia is significantly increased with minimal loss of specificity. Background: Acute transmural ischemia due to thrombotic coronary occlusion typically progresses to infarction. Its recognition is based on currently accepted ST-elevation myocardial infarction (STEMI) criteria with suboptimal sensitivity, which could be potentially increased by consideration of the principle that each of the 12 ECG leads can be inverted to provide an additional lead with the opposite (180 degrees) orientation, generating a 24-lead ECG. Methods: The study population included 162 patients who underwent prolonged coronary occlusion during elective percutaneoas transluminal coronary angioplasty. Balloon occlusion was performed in the left anterior descending coronary artery (51 patients), in the right coronary artery (67 patients), or in the left circumflex coronary artery (44 patients). To be classified as indicative of the epicardial injury current of acute ischemia, the ECGs had to fulfill either the criteria of a consensus document from the American College of Cardiology or the European Society of Cardiology or thresholds for the inverted leads based on a population study from Scotland. Results: The addition of -V1, -V2, -V3, -aVL, -I, aVR, and -III increased sensitivity from 61% to 78% (P &lt;= .01) and decreased specificity from 96% to 93% (P = .06). Conclusions: Addition of 7 leads from the 24-lead ECG, thus creating a 19-lead ECG, was found optimal for attaining high sensitivity while retaining high specificity when compared with the performance of the standard 12-lead ECG. (C) 2007 Elsevier Inc. All rights reserved.},
  author       = {Perron, Annick and Lim, Tobin and Pahlm-Webb, Ulrika and Wagner, Galen S. and Pahlm, Olle},
  issn         = {1532-8430},
  keyword      = {PTCA,sensitivity,specificity,acute myocardial infarction,12-lead ECG,acute coronary syndromes},
  language     = {eng},
  number       = {6},
  pages        = {463--469},
  publisher    = {Elsevier},
  series       = {Journal of Electrocardiology},
  title        = {Maximal increase in sensitivity with minimal loss of specificity for diagnosis of acute coronary occlusion achieved by sequentially adding leads from the 24-lead electrocardiogram to the orderly sequenced 12-lead electrocardiogram},
  url          = {http://dx.doi.org/10.1016/j.jelectrocard.2007.07.002},
  volume       = {40},
  year         = {2007},
}