Cardiogoniometric parameters for detection of coronary artery disease at rest as a function of stenosis localization and distribution

Abstract

Cardiogoniometry (CGM), a spatiotemporal electrocardiologic 5-lead method with automated analysis, may be useful in primary healthcare for detecting coronary artery disease (CAD) at rest. Our aim was to systematically develop a stenosis-specific parameter set for global CAD detection. In 793 consecutively admitted patients with presumed non-acute CAD, CGM data were collected prior to elective coronary angiography and analyzed retrospectively. 658 patients fulfilled the inclusion criteria, 405 had CAD verified by coronary angiography; the 253 patients with normal coronary angiograms served as the non-CAD controls. Study patients--matched for age, BMI, and gender--were angiographically assigned to 8 stenosis-specific CAD categories or to the controls. One CGM parameter possessing significance (P < .05) and the best diagnostic accuracy was matched to one CAD category. The area under the ROC curve was .80 (global CAD versus controls). A set containing 8 stenosis-specific CGM parameters described variability of R vectors and R-T angles, spatial position and potential distribution of R/T vectors, and ST/T segment alterations. Our parameter set systematically combines CAD categories into an algorithm that detects CAD globally. Prospective validation in clinical studies is ongoing.

Cardiogoniometry as a diagnostic tool in patients with acute coronary syndromes: results of the CGM@ACS trial

“…Note the R-loops ( blue ) and T-loops ( green ) of 12 heart cycles and maximum vectors of both loops ( red ). The maximum vectors are calculated on the median loops (with kind permission from Springer Science + Business Media from [11], figure number 1)…”

“…Velocities were classified as absolute values and ratios of the P, R and T-loops. In addition, all parameters were classified according to variability (adapted from [11]). As CAD may alter the surface potential of the global cardiac activity in different ways, depending on the affected area of the myocardium, a combination of independent penalising variables has been compiled to gender and rhythm specific sets and is used in the standard CGM method since 2008.…”

“…It was introduced by Sanz et al [9] and has been adjusted for detection of coronary artery disease (CAD) in recent years by Schüpbach and Hübner [10, 11]. In a prospective cohort of 332 subjects undergoing coronary angiography, the diagnostic accuracy of CGM was 71 % for detecting >50 % stenoses of the coronary arteries and thereby significantly better than that of a 12-lead ECG ( p  < 0.003) [10].…”

Electrocardiologic and related methods of non-invasive detection and risk stratification in myocardial ischemia: state of the art and perspectives

“…For global CAD detection by CGM, Huebner et al systematically developed a stenosis-specific parameter set [51]. A total of 658 study patients, matched for age, BMI, and gender, were angiographically assigned to 8 stenosis-specific CAD categories or to the controls.…”

Accuracy of cardiogoniometry compared with electrocardiography in the diagnosis of coronary artery disease

“…ECGs with persistent or transient horizontal or down-sloping ST depression ≥ 0.05 mV in two contiguous leads and/or T inversion ≥ 0.1 mV in two contiguous leads with prominent R wave were regarded as indicative of myocardial ischemia. Therefore, all registered positive; with all other patients registered as negative (9,10). Statistical analysis: Statistical analyses were performed with SPSS (ver 15; SPSS Inc. Chicago, Illinois).…”