Computerized two-lead resting ECG analysis for the detection of coronary artery stenosis after coronary revascularization

Abstract

Background: Resting electrocardiogram (ECG) shows limited sensitivity and specificity for the detection of coronary artery disease (CAD), where patients with a history of coronary revascularization may pose special challenges. Several methods exist to enhance sensitivity and specificity of resting ECG for diagnosis of CAD, but such methods are not better than a specialist's judgement. We compared a new computer-enhanced, resting ECG analysis device, 3DMP, to coronary angiography to evaluate the device's accuracy in detecting hemodynamically relevant CAD.Methods: A convenience sample of 172 patients with a history of coronary revascularization scheduled for coronary angiography was evaluated with 3DMP before coronary angiography. 3DMP's sensitivity and specificity in detecting hemodynamically relevant coronary stenosis as diagnosed with coronary angiography were calculated as well as odds ratios for the 3DMP severity score and coronary artery disease risk factors.Results: The 3DMP system accurately identified 50 of 55 patients as having hemodynamically relevant stenosis (sensitivity 90.9%, specificity 88.0%). Positive and negative predictive values for the identification of coronary stenosis as diagnosed in coronary angiograms were 62.7% and 97.8% respectively. Risk and demographic factors in a logistic regression model had a markedly lower predictive power for the presence of coronary stenosis in these patients than did 3DMP severity score (odds ratio 2.04 [0.74-5.62] vs. 73.57 [25.10-215.68]). A logistic regression combining severity score with risk and demographic factors did not add significantly to the prediction quality (odds ratio 80.00 [27.03-236.79]).Conclusions: 3DMP's computer-based, mathematically derived analysis of resting two-lead ECG data provides detection of hemodynamically relevant CAD in patients with a history of coronary revascularization with high sensitivity and specificity that appears to be at least as good as those reported for other resting and/or stress ECG methods currently used in clinical practice.

Noninvasive mathematical analysis of spectral electrocardiographic components for coronary lesions of intermediate to obstructive stenosis severity–relationship with classic and functional SYNTAX score

“…Compared with the ischemia level in the previous reports , the SS and FSS in the present study have better prognostic values . Therefore, the relationship between the MCG, and the SS and FSS observed in this study might contribute not only to the reduction of unnecessary CAGs but also in providing the potential risk stratification, especially in patients who are not able to exercise and have low kidney function.…”

“…Hence, in the clinical setting, many unnecessary CAGs are often performed, resulting in increased risks of safety and economic problems. Meanwhile, the MCG has been studied as an innovative computational electrophysiological signal analysis tool for the noninvasive diagnosis of relevant ischemia . In the present study, we related the relatively high accuracy of the MCG to the FSS, therefore providing an alternative for contemporary noninvasive diagnostic modalities for the detection of relevant ischemia as a gatekeeper for CAG, especially in patients who are not able to perform exercise and have low kidney function.…”

“…The multifunction cardiogram (MCG) is a new computer‐enhanced, multiphase, resting electrocardiographic (ECG) analysis device that improves the quality of noninvasive tests. It has been used to determine the optimal decision‐making algorithm for the evaluation of suspected obstructive CAD . Recently, we reported the association between noninvasive MCG and classic coronary lesion scores .…”

Serum ferritin and transferrin levels as serologic markers of methylene diphenyl diisocyanate–induced occupational asthma

“…When we applied the transferrin cutoff value (2.48 mg/mL), the sensitivity and specificity decreased to 71.43% and 51.02%, with 0.612 (95% CI, 0.396-0.829; P 5 .400) of the AUC value. When both parameters were combined to improve the discriminating power, 21 the AUC value increased to 0.789 (95% CI, 0.580-0.991; P 5.020), whereas the sensitivity and specificity increased to 71.43% and 85.71%, respectively (Table IV).…”

The Diagnostic Performance of Multifunction Cardiogram (MCG) in Functional Myocardial Ischemia

“…However, severity scores could vary in each session and the descriptive results from the session analysis could not be used to categorize the severity score objectively and quantitatively in the clinical study. Previous reports suggesting the high accuracy of MCG severity score in detecting coronary artery stenosis did not adequately describe the methodologies to derive the certain severity score for a given patient from the scores obtained in several sessions . In an attempt to follow an objective methodology, we selected the average and maximum value of MCG severity score among two or three sessions for the current analysis in MED‐FIT.…”