Joseph Boone Muhlestein1, Jeffrey L Anderson1, Charles F Bethea2, Harry W Severance3, Robert J Mentz4, Gregory W Barsness5, Alejandro Barbagelata6, David Albert7, Viet T Le8, T Jared Bunch9, Frank Yanowitz1, Heidi T May10, Benjamin Chisum10, Brianna S Ronnow10, Joseph Brent Muhlestein11. 1. Intermountain Medical Center, Intermountain Heart Institute, Salt Lake City, Utah; University of Utah, Department of Internal Medicine, Salt Lake City, Utah. 2. Integris Heart Hospital, Oklahoma City, Oklahoma. 3. Erlanger Institute for Clinical Research, UT College of Medicine, Chattanooga, Tennessee; Duke University, Durham, North Carolina. 4. Duke University, Durham, North Carolina. 5. Mayo Clinic, Rochester, Minnesota. 6. Catholic University Buenos Aires, Argentina. 7. AliveCor™ Corporation, San Franscisco, California. 8. Intermountain Medical Center, Intermountain Heart Institute, Salt Lake City, Utah; Rocky Mountain University of Health Professions, Masters of Physician Assistant Studies Program, Provo, Utah. 9. Intermountain Medical Center, Intermountain Heart Institute, Salt Lake City, Utah; Stanford University, Department of Internal Medicine, Palo Alto, California. 10. Intermountain Medical Center, Intermountain Heart Institute, Salt Lake City, Utah. 11. Intermountain Medical Center, Intermountain Heart Institute, Salt Lake City, Utah; University of Utah, Department of Internal Medicine, Salt Lake City, Utah. Electronic address: JBrent.Muhlestein@imail.org.
Abstract
BACKGROUND: The rate-limiting step in STEMI diagnosis often is the availability of a 12-lead electrocardiogram (ECG) and its interpretation. The potential may exist to speed the availability of 12-lead ECG information by using commonly available mobile technologies. We sought to test whether combining serial smartphone single-lead ECGs to create a virtual 12-lead ECG can accurately diagnose STEMI. METHODS: Consenting patients presenting with symptoms consistent with a possible STEMI had contemporaneous standard 12-lead and smartphone '12-lead equivalent' ECG (produced by electronically combining serial single-lead ECGs) recordings obtained. Matched ECGs were evaluated qualitatively and quantitatively by a panel of blinded readers and classified as STEMI/STEMI equivalent (LBBB), Not-STEMI, or uninterpretable. Interpretable ECG pairs were graded as showing good, fair, or poor correlation. RESULTS: Two hundred four subjects (age = 60 years, males = 57%, STEMI activation = 45%) were enrolled from 5 international sites. Smartphone ECG quality was graded as good in 151 (74.0%), fair in 32 (15.7%), poor in 8 (3.9%), and uninterpretable in 13 (6.4%). A STEMI/STEMI equivalent diagnosis was identified by standard 12-lead ECG in 57/204 (27.9%) recordings. For all interpretable pairs of smartphone ECGs compared with standard ECGs (n = 190), the sensitivity, specificity, and positive and negative predictive values for STEMI/STEMI equivalent by smartphone were 0.89, 0.84, 0.70 and 0.95, respectively. CONCLUSIONS: A '12-lead equivalent' ECG obtained from multiple serial single-lead ECGs from a smartphone can identify STEMI with good correlation to a standard 12-lead ECG. This technology holds promise to improve outcomes in STEMI by enhancing the reach and speed of diagnosis and thereby early treatment.
BACKGROUND: The rate-limiting step in STEMI diagnosis often is the availability of a 12-lead electrocardiogram (ECG) and its interpretation. The potential may exist to speed the availability of 12-lead ECG information by using commonly available mobile technologies. We sought to test whether combining serial smartphone single-lead ECGs to create a virtual 12-lead ECG can accurately diagnose STEMI. METHODS: Consenting patients presenting with symptoms consistent with a possible STEMI had contemporaneous standard 12-lead and smartphone '12-lead equivalent' ECG (produced by electronically combining serial single-lead ECGs) recordings obtained. Matched ECGs were evaluated qualitatively and quantitatively by a panel of blinded readers and classified as STEMI/STEMI equivalent (LBBB), Not-STEMI, or uninterpretable. Interpretable ECG pairs were graded as showing good, fair, or poor correlation. RESULTS: Two hundred four subjects (age = 60 years, males = 57%, STEMI activation = 45%) were enrolled from 5 international sites. Smartphone ECG quality was graded as good in 151 (74.0%), fair in 32 (15.7%), poor in 8 (3.9%), and uninterpretable in 13 (6.4%). A STEMI/STEMI equivalent diagnosis was identified by standard 12-lead ECG in 57/204 (27.9%) recordings. For all interpretable pairs of smartphone ECGs compared with standard ECGs (n = 190), the sensitivity, specificity, and positive and negative predictive values for STEMI/STEMI equivalent by smartphone were 0.89, 0.84, 0.70 and 0.95, respectively. CONCLUSIONS: A '12-lead equivalent' ECG obtained from multiple serial single-lead ECGs from a smartphone can identify STEMI with good correlation to a standard 12-lead ECG. This technology holds promise to improve outcomes in STEMI by enhancing the reach and speed of diagnosis and thereby early treatment.
Authors: David Duncker; Wern Yew Ding; Susan Etheridge; Peter A Noseworthy; Christian Veltmann; Xiaoxi Yao; T Jared Bunch; Dhiraj Gupta Journal: Sensors (Basel) Date: 2021-04-05 Impact factor: 3.576
Authors: David Calvin Goff; Sadiya Sana Khan; Donald Lloyd-Jones; Donna K Arnett; Mercedes R Carnethon; Darwin R Labarthe; Matthew Shane Loop; Russell V Luepker; Michael V McConnell; George A Mensah; Mahasin S Mujahid; Martin Enrique O'Flaherty; Dorairaj Prabhakaran; Véronique Roger; Wayne D Rosamond; Stephen Sidney; Gina S Wei; Janet S Wright Journal: Circulation Date: 2021-02-22 Impact factor: 29.690