title: ECG-Based Detection of Early Myocardial Ischemia in a Computational Model: Impact of Additional Electrodes, Optimal Placement, and a New Feature for ST Deviation.
abstract: In case of chest pain, immediate diagnosis of myocardial ischemia is required to respond with an appropriate treatment. The diagnostic capability of the electrocardiogram (ECG), however, is strongly limited for ischemic events that do not lead to ST elevation. This computational study investigates the potential of different electrode setups in detecting early ischemia at 10 minutes after onset: standard 3-channel and 12-lead ECG as well as body surface potential maps (BSPMs). Further, it was assessed if an additional ECG electrode with optimized position or the right-sided Wilson leads can improve sensitivity of the standard 12-lead ECG. To this end, a simulation study was performed for 765 different locations and sizes of ischemia in the left ventricle. Improvements by adding a single, subject specifically optimized electrode were similar to those of the BSPM: 2-11% increased detection rate depending on the desired specificity. Adding right-sided Wilson leads had negligible effect. Absence of ST deviation could not be related to specific locations of the ischemic region or its transmurality. As alternative to the ST time integral as a feature of ST deviation, the K point deviation was introduced: the baseline deviation at the minimum of the ST-segment envelope signal, which increased 12-lead detection rate by 7% for a reasonable threshold.
authors.affiliation: Karlsruhe Institute of Technology (KIT), Institute of Biomedical Engineering, Kaiserstraße 12, 76128 Karlsruhe, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Loewe
authors.affiliation: Karlsruhe Institute of Technology (KIT), Institute of Biomedical Engineering, Kaiserstraße 12, 76128 Karlsruhe, Germany.
authors.forename: Walther H W
authors.initials: WH
authors.lastname: Schulze
authors.affiliation: Karlsruhe Institute of Technology (KIT), Institute of Biomedical Engineering, Kaiserstraße 12, 76128 Karlsruhe, Germany ; Siemens Healthcare Malaysia, Petaling Jaya, 46350 Selangor, Malaysia.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Jiang
authors.affiliation: Karlsruhe Institute of Technology (KIT), Institute of Biomedical Engineering, Kaiserstraße 12, 76128 Karlsruhe, Germany.
authors.forename: Mathias
authors.initials: M
authors.lastname: Wilhelms
authors.affiliation: Städtisches Klinikum Karlsruhe, Medizinische Klinik IV, Moltkestraße 90, 76133 Karlsruhe, Germany.
authors.forename: Armin
authors.initials: A
authors.lastname: Luik
authors.affiliation: Karlsruhe Institute of Technology (KIT), Institute of Biomedical Engineering, Kaiserstraße 12, 76128 Karlsruhe, Germany.
authors.forename: Olaf
authors.initials: O
authors.lastname: Dössel
authors.affiliation: Karlsruhe Institute of Technology (KIT), Institute of Biomedical Engineering, Kaiserstraße 12, 76128 Karlsruhe, Germany.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Seemann
mesh_terms: D003198:Computer Simulation; D004562:Electrocardiography / Q000379:methods*; D004566:Electrodes; D006801:Humans; D008955:Models, Cardiovascular; D017202:Myocardial Ischemia / Q000503:physiopathology*