title: 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.
abstract: BACKGROUND
  Many graphical methods for displaying ST-segment deviation in the ECG have been tried for enhancing decision-making in patients with suspected acute coronary syndromes. Computed electrocardiographic imaging (CEI), based on a mathematical inverse solution, has been recently applied to transform ST-J point measurements made in conventional 12-lead ECG into a display of epicardial potentials in bull's-eye format. The purpose of this study is to assess utility of CEI in the clinical setting.
  
  
  METHODS
  In 99 patients with stable coronary disease, 12-lead ECGs were recorded during elective percutaneous coronary intervention (PCI), first before balloon-catheter insertion and then when an intracoronary balloon blocked blood supply to a region of myocardium for more than 4minutes (typically 5minutes). Four groups of patients were additionally studied, namely those with preexcitation, pericarditis, early repolarization syndrome (ERS), and left ventricular hypertrophy (LVH) with strain. Comparisons between performances of published criteria for ST-elevation myocardial infarction (STEMI) and quantitative as well as visual assessment of CEI images were based on sensitivities and specificities.
  
  
  RESULTS
  Visual assessment of CEI outperformed STEMI criteria. This was especially evident for the capability of detecting LCx occlusion with sensitivities for STEMI criteria=35% and for visual assessment of CEI by 2 physicians=71%, i. e. twice as many patients were correctly identified by CEI. False positive rates for CEI were low in patients with LVH with strain as well as with preexcitation for both methods. For pericarditis and ERS, visual as well as quantitative assessment of CEI performed better than STEMI criteria.
  
  
  CONCLUSIONS
  Visual assessment of CEI is a promising method for increasing the accuracy of ECG-based triage to PCI or conservative care.
authors.affiliation: Department of Clinical Physiology, University Hospital, Lund, Sweden.
authors.forename: Shahnaz
authors.initials: S
authors.lastname: Akil
authors.forename: Mariam
authors.initials: M
authors.lastname: Al-Mashat
authors.forename: Bo
authors.initials: B
authors.lastname: Hedén
authors.forename: Fredrik
authors.initials: F
authors.lastname: Hedeer
authors.forename: Jonas
authors.initials: J
authors.lastname: Jögi
authors.forename: John J
authors.initials: JJ
authors.lastname: Wang
authors.forename: Galen S
authors.initials: GS
authors.lastname: Wagner
authors.forename: James W
authors.initials: JW
authors.lastname: Warren
authors.forename: Olle
authors.initials: O
authors.lastname: Pahlm
authors.forename: B Milan
authors.initials: BM
authors.lastname: Horáček
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D018780:Body Surface Potential Mapping / Q000379:methods*; D002648:Child; D054059:Coronary Occlusion / Q000175:diagnosis*; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014584:User-Computer Interface; D055815:Young Adult