Body surface mapping in the ED evaluation of the patient with chest pain: use of the 80-lead electrocardiogram system

Self, Wesley H.; Mattu, Amal; Martin, Marcus L.; Holstege, Christopher P.; Preuss, Jeffrey M.; Brady, William J.

doi:10.1016/j.ajem.2005.04.008

Cited by 20 publications

(8 citation statements)

References 49 publications

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“…Yet the need to avoid sending any patient with ACS home from the ED has led to increasing hospital admissions and use of vast resources on many patients who ultimately do not have a diagnosis of ACS. 12,33 This challenge has led to the development of new objective tools, including new technologies (15 lead ECGs, 34,35 body surface mapping, [36][37][38][39][40] neural networks, 41,42 serum biomarkers, 25,27,28,30,[43][44][45][46][47][48] stress testing, 5,33,49,50 computed tomography [CT] coronary angiography 51,52 ) and risk stratification tools 11,31,53-55 to aid physicians in decision-making. Although promising, none of these are as yet widely accepted as a means to identify patients who can be safely discharged from the ED.…”

Section: Discussionmentioning

confidence: 99%

Emergency Physician High Pretest Probability for Acute Coronary Syndrome Correlates with Adverse Cardiovascular Outcomes

Chandra

Lindsell

Diercks

et al. 2009

Academic Emergency Medicine

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Objectives: The value of unstructured physician estimate of risk for disease processes, other than acute coronary syndrome (ACS), has been demonstrated. The authors sought to evaluate the predictive value of unstructured physician estimate of risk for ACS in emergency department (ED) patients without obvious initial evidence of a cardiac event.Methods: This was a post hoc secondary analysis of the Internet Tracking Registry for Acute Coronary Syndromes (i*trACS), a prospectively collected multicenter data registry of patients over the age of 18 years presenting to the ED with symptoms of ACS between 1999 and 2001. In this registry, following patient history, physical exam, and electrocardiogram (ECG), the unstructured treating physician estimate of risk was recorded. A 30-day follow-up and a medical record review were used to determine rates of adverse cardiac events, death, myocardial infarction (MI), or revascularization procedure. The analysis included all patients with nondiagnostic ECG changes, normal initial biomarkers, and a non-MI initial impression from the registry and excluded those without complete data or who were lost to follow-up. Data were stratified by unstructured physician risk estimate: noncardiac, low risk, high risk, or unstable angina.Results: Of 15,608 unique patients in the registry, 10,145 met inclusion ⁄ exclusion criteria. Patients were defined as having unstable angina in 6.0% of cases; high risk, 23.5% of cases; low risk, 44.2%; and noncardiac, 26.3% of cases. Adverse cardiac event rates had an inverse relationship, decreasing from 22.0% (95% confidence interval [CI] = 18.8% to 25.6%) for unstable angina, 10.2% (95% CI = 9.0% to 11.5%) for those stratified as high risk, 2.2% (95% CI = 1.8% to 2.6%) for low risk, and to 1.8% (95% CI = 1.4% to 2.4%) for noncardiac. The relative risk (RR) of an adverse cardiac event for those with an initial label of unstable angina compared to those with a low-risk designation was 10.2 (95% CI = 8.0 to 13.0). The RR of an event for those with a high-risk initial impression compared to those with a low-risk initial impression was 4.7 (95% CI = 3.8 to 5.9). The risk of an event among those with a low-risk initial impression was the same as for those with a noncardiac initial impression (RR = 0.83, 95% CI = 0.6 to 1.2). Conclusions:In ED patients without obvious initial evidence of a cardiac event, unstructured emergency physician (EP) estimate of risk correlates with adverse cardiac outcomes.ACADEMIC EMERGENCY MEDICINE 2009; 16:740-748 ª

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Section: Discussionmentioning

confidence: 99%

Emergency Physician High Pretest Probability for Acute Coronary Syndrome Correlates with Adverse Cardiovascular Outcomes

Chandra

Lindsell

Diercks

et al. 2009

Academic Emergency Medicine

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“…Melendez, Jones, and Salecedo (1978) used three additional leads (V7-V9) and reported improved detection of AMI. Body surface mapping provides more complete visualization of the electrical activity of the heart and a topographical electrical display of a larger area of the thoracic surface than the traditional 12-lead ECG (Lefebvre & Hoekstra, 2007;Self et al, 2006). This technology has come into clinical use only recently.…”

Section: Rationale For Use Of Body Surface Mappingmentioning

confidence: 99%

“…The color contour maps can be displayed on a torso image or as a flat map (Figure 2). For a more detailed review of the specifics of BSM, the reader is referred to an article by Self et al (2006). Just like a typical 12-lead ECG machine, the new device has easily portable hardware and userfriendly software ( Figure 3).…”

Section: Rationale For Use Of Body Surface Mappingmentioning

confidence: 99%

“…Widespread adoption of the new technology in clinical settings has to date been limited not only by the need for additional education of personnel but also by the cost of the hardware, disposable parts, and recordings. Studies of the 80-lead ECG are available to support its clinical use in the cardiac catheterization laboratory and during cardiac stress testing (Self et al, 2006). Research also is available documenting the importance of BSM in the ED, and recent studies will be reviewed here.…”

Section: Rationale For Use Of Body Surface Mappingmentioning

confidence: 99%

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Body Surface Mapping Improves Diagnosis of Acute Myocardial Infarction in the Emergency Department

Franks

Lawson

2012

Advanced Emergency Nursing Journal

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Traditionally, the diagnosis of acute myocardial infarction (AMI) in emergency departments is done through an assessment of history and presenting symptoms, 12-lead electrocardiogram (ECG), and cardiac biomarkers. The 12-lead ECG is not highly sensitive for detecting ECG changes, and some infarctions may be missed. Failure to identify patients in the early stages of AMI can result in failure to provide beneficial therapies. New technology, the 80-lead ECG, uses body surface mapping to provide a more comprehensive view of cardiac electrical activity. Body surface mapping has greater sensitivity in detecting AMI in the inferoposterior portions of the left ventricle and the right ventricle. Portable hardware and user-friendly software coupled with an easily applied disposable torso vest containing the electrodes produce a 12-lead ECG, 80-lead ECG, and color contour torso or flat map showing ECG changes. Recent studies support the use of 80-lead body surface mapping for detecting AMI in the emergency department.

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“…Over the years, various efforts have been made to address the diagnostic limitations of the ECG, including but not limited to vectorcardiography, body surface mapping, and magnetocardiography [3][4][5]. One of the earliest examples of such efforts was vectorcardiography and primarily used from 1940s to the 1970s.…”

Section: Introductionmentioning

confidence: 99%

Algorithm for quantitative 3 dimensional analysis of ECG signals improves myocardial diagnosis over cardiologists in diabetic patients

Wenzel¹,

George²,

Lakkireddy

et al. 2011

2011 Annual International Conference of the IEEE Engineering in Medicine and Biology Society

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Body surface mapping in the ED evaluation of the patient with chest pain: use of the 80-lead electrocardiogram system

Cited by 20 publications

References 49 publications

Emergency Physician High Pretest Probability for Acute Coronary Syndrome Correlates with Adverse Cardiovascular Outcomes

Emergency Physician High Pretest Probability for Acute Coronary Syndrome Correlates with Adverse Cardiovascular Outcomes

Body Surface Mapping Improves Diagnosis of Acute Myocardial Infarction in the Emergency Department

Algorithm for quantitative 3 dimensional analysis of ECG signals improves myocardial diagnosis over cardiologists in diabetic patients

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