Clinical application of a second generation electrocardiographic computer program

Pipberger, Hubert V.; McCaughan, Donald; Littmann, David; Pipberger, Hanna A.; Cornfield, Jerome; Dunn, Rosalie A.; Batchlor, Charles D.; Berson, Alan S.

doi:10.1016/0002-9149(75)90044-2

Cited by 91 publications

(14 citation statements)

References 25 publications

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“…Beginning in the 1960s, Pipberger et al applied a multivariate approach to the conventional ECG (orthogonal ± 12-lead) to obtain excellent diagnostic accuracies, albeit generally only for those conditions considered classically diagnosable by ECG, such as ventricular hypertrophy and previous infarction[38,39]. Our results therefore confirm Pipberger et al's suggestion that the diagnostic utility of resting ECG could be continuously improved through computer-automated multivariate analyses validated against ECG-independent diagnostic information.…”

Section: Discussionsupporting

confidence: 78%

Accuracy of advanced versus strictly conventional 12-lead ECG for detection and screening of coronary artery disease, left ventricular hypertrophy and left ventricular systolic dysfunction

Schlegel

Kulecz

Feiveson

et al. 2010

BMC Cardiovasc Disord

117

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BackgroundResting conventional 12-lead ECG has low sensitivity for detection of coronary artery disease (CAD) and left ventricular hypertrophy (LVH) and low positive predictive value (PPV) for prediction of left ventricular systolic dysfunction (LVSD). We hypothesized that a ~5-min resting 12-lead advanced ECG test ("A-ECG") that combined results from both the advanced and conventional ECG could more accurately screen for these conditions than strictly conventional ECG.MethodsResults from nearly every conventional and advanced resting ECG parameter known from the literature to have diagnostic or predictive value were first retrospectively evaluated in 418 healthy controls and 290 patients with imaging-proven CAD, LVH and/or LVSD. Each ECG parameter was examined for potential inclusion within multi-parameter A-ECG scores derived from multivariate regression models that were designed to optimally screen for disease in general or LVSD in particular. The performance of the best retrospectively-validated A-ECG scores was then compared against that of optimized pooled criteria from the strictly conventional ECG in a test set of 315 additional individuals.ResultsCompared to optimized pooled criteria from the strictly conventional ECG, a 7-parameter A-ECG score validated in the training set increased the sensitivity of resting ECG for identifying disease in the test set from 78% (72-84%) to 92% (88-96%) (P < 0.0001) while also increasing specificity from 85% (77-91%) to 94% (88-98%) (P < 0.05). In diseased patients, another 5-parameter A-ECG score increased the PPV of ECG for LVSD from 53% (41-65%) to 92% (78-98%) (P < 0.0001) without compromising related negative predictive value.ConclusionResting 12-lead A-ECG scoring is more accurate than strictly conventional ECG in screening for CAD, LVH and LVSD.

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Section: Discussionsupporting

confidence: 78%

Accuracy of advanced versus strictly conventional 12-lead ECG for detection and screening of coronary artery disease, left ventricular hypertrophy and left ventricular systolic dysfunction

Schlegel

Kulecz

Feiveson

et al. 2010

BMC Cardiovasc Disord

117

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“…Evaluations where these recommendations have not been used are of limited value because of bias introduced by observers or evaluators (Pipberger and Cornfield, 1973). While this recommendation has not been followed for evaluation of other systems, the diagnostic performance of the Veterans Administration program has been extensively tested against independent evidence for the diagnoses and found to be quite satisfactory and reliable (Brohet and Richman, 1979;Milliken et al, 1983;Pipberger et al, 1975). It is fortunate that these evaluations against independent evidence do exist.…”

Section: Discussionmentioning

confidence: 99%

A new microcomputer‐based ecg analysis system

Kyle

Klingeman

Conrad

et al. 1983

Clinical Cardiology

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Summary:A new automated ECG system using advances in microprocessor technology and computerized electrocardiography is described. This microcomputer-based system is self-contained and mobile. It acquires both the 12-lead and orthogonal lead (Frank) electrocardiograms and analyzes the latter within minutes. Software includes the program developed in the Veterans Administration which uses advanced statistical classification techniques and a large well-documented patient data base. Diagnostic probabilities are computed using a Bayesian approach. Diagnostic performance has been tested using independent clinical criteria and found to be quite accurate. This system enables the clinician to immediately review the computer's identifications, measurements, and diagnostic classifications and quickly * The ECG system was conceived by Jack Klingeman, who since 1965, has specialized in diagnostic techniques for noninvasive evaluation of cardiovascular disease. In cooperation with the other authors he implemented the system and began demonstrating its usefulness to the medical community. He completed the initial manuscript describing the system shortly before his death on July 27, 1982. use these results in clinical decision making. Serial comparisons are readily made since all previous recordings are stored on floppy diskettes. The use of microprocessors in this system makes it economically feasible for practicing physicians.

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“…Willems, who with his colleagues has applied statistical techniques to 3-and 12-lead ECGs [22] has stated that "this approach is similar to the thought process of a physician who, on interpreting an ECG, weights his diagnosis in the light of the known clinical condition and age of the patient" [23]. However, it does mean that the ECG interpretation is dependent upon the prior p(obabilities, as is evident from the early studies of Pipberger's group [24].…”

Section: The Early Daysmentioning

confidence: 99%

A Brief History of Computer-Assisted Electrocardiography

1990

Methods Inf Med

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Clinical application of a second generation electrocardiographic computer program

Cited by 91 publications

References 25 publications

Accuracy of advanced versus strictly conventional 12-lead ECG for detection and screening of coronary artery disease, left ventricular hypertrophy and left ventricular systolic dysfunction

Accuracy of advanced versus strictly conventional 12-lead ECG for detection and screening of coronary artery disease, left ventricular hypertrophy and left ventricular systolic dysfunction

A new microcomputer‐based ecg analysis system

A Brief History of Computer-Assisted Electrocardiography

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