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John J Wang

John J Wang

Philips Healthcare, USA & B Milan Horacek Dalhousie University, Canada

Title: Improved acute myocardial ischemia detection by vessel-specific leads (VSLs) derived from the 12-lead ECG

Biography

Biography: John J Wang

Abstract

To further improve existing criteria recommended by ACC/ESC for identifying patients with ST elevation myocardial infarction (STEMI) from the 12-lead ECG, we have developed new criteria based on ST deviation calculated from 3 “optimal” vessel-specific leads (VSLs) derived from the 12-lead ECG. The performance of the VSLs vs. STEMI criteria was evaluated using two independent datasets of 12-lead ECGs: the Glasgow dataset included admission ECGs of 116 patients who were hospitalized for chest pain and underwent contrast-enhanced cardiac MRI that confirmed AMI in 58 patients (50%) and the Lund dataset included ECGs of 100 patients (75% males, age: mean/range 52/12-83 years)  chosen to represent five subgroups with various causes of pathological ST-deviation, other than acute coronary occlusion: ventricular pre-excitation (n=12), acute pericarditis (n=26), ERS (n=14), LVH (n=26), and LBBB (n=22). Both STEMI criteria and VSLs method with and without an augmented LVH-specific derived lead were tested. Sensitivity (SE) and specificity (SP) were calculated and used as the performance measures for comparison. For 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 occlusion (n=13):  SE was improved from 31% to 69%. For the Lund dataset, SP test results using the STEMI and VSLs criteria were 100%/92%, 4%/88%, 29%/100%, 100%/96%, and 64%/68% for the five subgroups: pre-excitation, pericarditis, ERS, LVH, and LBBB, respectively. For the whole group, SP results were 57% for the STEMI criteria and 88% for the VSLs method. The performance improvement was statistically significant (p < 0.001). Based on these results we conclude that the new VSLs method has the potential to outperform the existing STEMI criteria in identifying patients who should receive emergent reperfusion therapy. This finding needs to be corroborated further on a larger study population.

References:

  1. Wang JJ, Pahlm, O, Wagner GS, Warren JW, Horacek BM, Sapp JL. Validation of the vessel-specific leads (VSLs) for detection of acute ischemia on a dataset with non-ischemic ST-segment deviation. J Electrocardiol 2016;49:800-806..
  2. Wang, J. Potential solutions for managing real-time ECG/arrhythmia monitoring alarms: A review. Computing in Cardiology 2016;43:301-304.
  3. Wang JJ, Title LM, Martin TN, Wagner GS, Warren JW, Horacek BM, Sapp JL. Validation of improved vessel-specific leads (VSLs) for detecting acute myocardial ischemia. J Electrocardiol 2015;48:1032-1039.
  4. Zong W, Kresge S, Lu H, Wang J. A real-time ST-segment monitoring algorithm based on a multi-channel waveform-length-transformation method for Q-onset and J-point detection. Computing in Cardiology 2014;41:641-644.
  5. Akil S, Al-Mashat M, Heden B, Hedeer F, Logi J, Wang JJ, Wagner GS, Warren JW, Pahlm O, Horáček BM. Discrimination of ST deviation caused by acute coronary occlusion from normal variants and other abnormal conditions, using computed electrocardiographic imaging based on 12-lead ECG. J Electrocardiol 2013;46:197-203