title: Comparative accuracy of manual versus computerized electrocardiographic measurement of J-, ST- and T-wave deviations in patients with acute coronary syndrome.
abstract: Accurate and rapid electrocardiographic interpretation is of crucial importance in acute coronary syndrome (ACS). Computerized electrocardiographic algorithms are often used in out-of-hospital settings. Their accuracy should be carefully validated in ACS, particularly in ST-elevation myocardial infarction. This study evaluated the comparative accuracy of lead-specific computer-based versus manual measurements of the J-point, ST-segment, and T-wave deviations in standard 12-lead electrocardiograms (ECGs) (excluding lead aVR). Sixty-nine consecutive patients with suspected ACS were included. The interobserver reliability in the determination of ST-segment deviation>or=0.2 mV in leads V2 and V3 was very good (kappa=0.94 and 0.93, respectively). Agreement between a cardiologist and the computer regarding ST elevation>or=0.2 mV in lead V2 was moderate (kappa=0.72) and in V3 was very good (kappa=0.85). For ST depression or elevation>or=0.05 mV in lead LIII, agreement was good and moderate (kappa=0.79 and 0.51, respectively). Bland-Altman analysis demonstrated clinically acceptable limits of agreement comparing measurements of the J point and the T wave, but clinically inadequate limits of agreement with respect to ST-segment deviation, between the electrocardiographer and the computer. The optimal cut-off points were 0.115 mV (sensitivity 89%, specificity 98%) for the computer program to detect ST elevation>or=0.2 mV and 0.045 mV (sensitivity 74%, specificity 99%) for revealing ST elevation>or=0.1 mV. It was found that automatically measured ST-segment deviations were smaller than those manually measured. In conclusion, a correction should be performed to obtain optimal results in the automated analysis of ECGs, because the results have important implications for clinical decision making.
authors.affiliation: Heart Center, Tampere University Hospital, Tampere, Finland. markku.eskola@pshp.fi
authors.forename: Markku J
authors.initials: MJ
authors.lastname: Eskola
authors.forename: Kjell C
authors.initials: KC
authors.lastname: Nikus
authors.forename: Liisa-Maria
authors.initials: LM
authors.lastname: Voipio-Pulkki
authors.forename: Heini
authors.initials: H
authors.lastname: Huhtala
authors.forename: Tiina
authors.initials: T
authors.lastname: Parviainen
authors.forename: Juha
authors.initials: J
authors.lastname: Lund
authors.forename: Tuomo
authors.initials: T
authors.lastname: Ilva
authors.forename: Pekka
authors.initials: P
authors.lastname: Porela
mesh_terms: D000208:Acute Disease; D003327:Coronary Disease / Q000503:physiopathology*; D004562:Electrocardiography / Q000379:methods*; D001330:Electronic Data Processing; D006801:Humans; D015588:Observer Variation; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013577:Syndrome