Body surface potential mapping of ST segment changes in acute myocardial infarction. Implications for ECG enrollment criteria for thrombolytic therapy.

Abstract

Analysis of BSPM identifies areas on the torso where the most significant ST changes most frequently occur in acute MI. Two leads from areas with the most abnormal ST changes achieve optimal classification in each MI class. Of these six leads, five are outside the standard precordial lead positions. ST depression is the most potent discriminator for each MI group and contains information independent from ST elevation. Quantitative analysis of ST magnitude at each electrode site allows determination of best thresholds for ECG criteria. Appropriate selection of ECG leads may help remove inconsistencies in current ECG selection criteria and improve comparability of treatment results.

Variation of ECG features on torso plane: An innovative approach to myocardial infarction detection

“…In this paper, we address a new method based on behavior of some important ECG's features affected by MI, includes Q-wave amplitude and ST-segment dispersion (depression and evaluation) [10,11]. We call consequent plots as Q and ST curves respectively.…”

Incremental Benefit of 80‐Lead Electrocardiogram Body Surface Mapping Over the 12‐Lead Electrocardiogram in the Detection of Acute Coronary Syndromes in Patients Without ST‐elevation Myocardial Infarction: Results from the Optimal Cardiovascular Diagnostic Evaluation Enabling Faster Treatment of Myocardial Infarction (OCCULT MI) Trial

“…The 80L has also displayed the potential for early detection of STEMI in specific regions of the myocardium, in particular detecting injury patterns in the right ventricular and posterior areas. 10 McClelland et al 12 studied patients admitted via the ED or mobile cardiac care unit with chest pain duration < 12 hours and compared the 80L mapping to the 12L and 12L plus physician interpretation for detection of MI. The sensitivity and specificity for MI detection were 32 and 98% for 12L, 45 and 94% for 12L plus physician, and 64 and 94% for 80L alone.…”

“…These initial studies of the 80L were all done in veryhigh-risk patients, where the pretest probability of MI was 22% to 62%. 4,[8][9][10][11] The use of the 80L in a more representative, moderate-to high-risk ED population has, to the best of our knowledge, never been reported prior to the Optimal Cardiovascular Diagnostic Evaluation Enabling Faster Treatment of Myocardial Infarction (OCCULT MI) study. 13 In addition, the analysis of ST depression as a high-risk ECG finding and the sensitivity of the 80L ECG for detection of ST depression or ST elevation in patients with MI and ACS have never been studied.…”

Activation patterns in atrial fibrillation: contributions of body surface potential mapping.

“…Multivariate analysis was used for optimal separation of patients based on discriminant indexes together with other diagnostic measurements namely duration of the ST-T segment, mid-QRS voltage measurement, etc. This analysis allowed the identification of optimum leads for discriminating patients with myocardial infarction, most of them outside the area sampled by the conventional ECG and showing better classification rates than the standard ECG [75].…”