Comparison of a new reduced lead set ECG with the standard ECG for diagnosing cardiac arrhythmias and myocardial ischemia
Comparison of a new reduced lead set ECG with the standard ECG for diagnosing cardiac arrhythmias and myocardial ischemia
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DOI：
10.1054/jelc.2002.37150
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发表时间：
2002-01-01
影响因子：
1.3
通讯作者：
Adams, MG
中科院分区：
文献类型：
--
作者：
Drew, BJ;Pelter, MM;Adams, MG
在少数患者中，来自缩减导联组配置的12导联心电图（ECG）与标准ECG不匹配。从减少数量的标准导联构建ECG应该最小化这个问题，因为所得到的12个导联中的一些总是包括“真正的”标准导联。本研究的目的是比较一种新的减少导联组的12导联心电图（“内插”心电图）与标准心电图诊断心律失常和急性心肌缺血的能力。内插ECG使用六个标准电极部位（肢体导联加上V-1和V-5），从中构建其余四个心前区导联（V-2、V-3、V-4和V-6）。使用来自2项前瞻性临床试验的数据比较标准和内插ECG，这些试验涉及649例患者，评价了1）急诊室胸痛（缺血组，n = 509）或2）心脏电生理实验室心动过速（心律失常组，n = 140）。标准和内插ECG对束支分支和分支传导阻滞、左心房扩大、右心室肥大、既往下壁心肌梗死（MI）以及室性心动过速和室上性心动过速伴异常传导的区别的诊断相同。既往前壁MI的一致率为99%（kappa，0.935，P = 0.000）。急诊科胸痛患者初始心电图记录的急性心肌缺血的一致性百分比为99.2%（kappa，0.978，P = 0.000）。在120例连续标准12导联心电图监测ST事件的患者中，116例（97%）也符合内插心电图短暂缺血的标准（即，DeltaST大于或等于100 μ V，大于或等于1导联，持续时间大于或等于1分钟）。内插12导联ECG与标准ECG在诊断多种心脏异常（包括宽QRS波心动过速和急性心肌缺血）方面具有可比性。这种FCG方法的优点是临床医生熟悉标准电极部位，并且12根导线中有8根是“真正的”标准导线。因此，保留了诊断宽QRS波群心动过速和束分支和分支阻滞的QRS轴和形态学标准。
In a few patients, 12-lead electrocardiograms (ECGs) derived from reduced-lead-set configurations do not match the standard ECG. Constructing an ECG from a reduced number of standard leads should minimize this problem because some of the resultant 12 leads would always include "true" standard leads. The purpose of this study was to compare the ability of a new reduced-lead-set 12-lead ECG ("interpolated" ECG) with the standard ECG to diagnose cardiac arrhythmias and acute myocardial ischemia. The interpolated ECG uses six standard electrode sites (limb leads plus V-1 and V-5), from which the remaining four precordial leads (V-2, V-3, V-4, and V-6) are constructed. Standard and interpolated ECGs were compared using data from 2 prospective clinical trials involving 649 patients evaluated for 1) chest pain in the emergency department (ischemia group, n = 509) or 2) tachycardias in the cardiac electrophysiology laboratory (arrhythmia group, n = 140). Diagnoses were identical between standard and interpolated ECGs for bundle branch and fascicular blocks, left atrial enlargement, right ventricular hypertrophy, prior inferior myocardial infarction (MI), and the distinction of ventricular tachycardia from supraventricular tachycardia with aberrant conduction. There was 99% agreement for prior anterior MI (kappa, .935, P =.000). The percent agreement for acute myocardial ischemia on the initial ECG recorded in chest-pain patients in the emergency department was 99.2% (kappa, .978, P =.000). Of the 120 patients who had ST events with continuous standard 12-lead ECG monitoring, 116 (97%) also had criteria for transient ischemia with the interpolated ECG (ie, DeltaST greater than or equal to 100 muV in greater than or equal to1 lead(s) lasting greater than or equal to1 minute(s). The interpolated 12-lead ECG is comparable to the standard ECG for diagnosing Multiple cardiac abnormalities, including wide-QRS-complex tachycardias and acute myocardial ischemia. The advantages of this FCG method are that the standard electrode sites are familiar to clinicians and that eight of the 12 leads are "true" standard leads. Hence, QRS-axis and morphology criteria for diagnosing wide-QRS-complex tachycardia and bundle branch and fascicular blocks are preserved.