title: Accuracy of the EASI 12-lead electrocardiogram compared to the standard 12-lead electrocardiogram for diagnosing multiple cardiac abnormalities.
abstract: This study was performed to compare a derived 12-lead electrocardiogram (ECG) using a simple 5-electrode lead configuration (EASI 12-lead) with the standard ECG for multiple cardiac diagnoses. Accurate diagnosis of arrhythmias and ischemia often require analysis of multiple (ideally, 12) ECG leads; however, continuous 12-lead monitoring is impractical in hospital settings. EASI and standard ECGs were compared in 540 patients, 426 of whom also had continuous 12-lead ST segment monitoring with both lead methods. Independent standards relative to a correct diagnosis were used whenever possible, for example, echocardiographic data for chamber enlargement-hypertrophy, and troponin levels for acute infarction. Percent agreement between the 2 methods were: cardiac rhythm, 100%; chamber enlargement-hypertrophy, 84%-99%; right and left bundle branch block, 95% and 97%, respectively; left anterior and posterior fascicular block, 97% and 99%, respectively; prior anterior and inferior infarction, 95% and 92%, respectively. There was very little variation between the 2 lead methods in cardiac interval measurements; however, there was more variation in P, QRS, and T-wave axes. Of the 426 patients with ST monitoring, 138 patients had a total of 238 ST events (26, acute infarction; 62, angioplasty-induced ischemia; 150, spontaneous transient ischemia). There was 100% agreement between the 2 methods for acute infarction, 95% agreement for angioplasty-induced ischemia, and 89% agreement for transient ischemia. EASI and standard 12-lead ECGs are comparable for multiple cardiac diagnoses; however, serial ECG changes (eg, T-wave changes) should be assessed using one consistent 12-lead method.
authors.affiliation: Department of Physiological Nursing, University of California, San Francisco, 94143-0610, USA.
authors.forename: B J
authors.initials: BJ
authors.lastname: Drew
authors.forename: M M
authors.initials: MM
authors.lastname: Pelter
authors.forename: S F
authors.initials: SF
authors.lastname: Wung
authors.forename: M G
authors.initials: MG
authors.lastname: Adams
authors.forename: C
authors.initials: C
authors.lastname: Taylor
authors.forename: G T
authors.initials: GT
authors.lastname: Evans
authors.forename: E
authors.initials: E
authors.lastname: Foster
mesh_terms: D000368:Aged; D000789:Angina, Unstable / Q000175:diagnosis / Q000503:physiopathology; D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000503:physiopathology; D006332:Cardiomegaly / Q000175:diagnosis / Q000503:physiopathology; D004562:Electrocardiography / Q000295:instrumentation*; D015716:Electrocardiography, Ambulatory / Q000295:instrumentation; D004867:Equipment Design; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000503:physiopathology; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012815:Signal Processing, Computer-Assisted / Q000295:instrumentation*; D014672:Vectorcardiography / Q000295:instrumentation*