Diagnostic accuracy of the vectorcardiogram and electrocardiogram

Simonson, Ernst; Tuna, Naip; Okamoto, Noboru; Toshima, Hironori

doi:10.1016/0002-9149(66)90379-1

Cited by 118 publications

(14 citation statements)

References 24 publications

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“…Various authors demonstrated reasonable interchangeability as far as clinical diagnosis is concerned between the orthogonal corrected leads and the standard 12-lead ECG.62' 63,64 Similar conclusions can be drawn from studies more specifically aimed at ischemic heart disease and the stress ECG.65 66 Therefore the findings in our comparison of the 9-lead system with the Frank leads can be used to assess the improvement in diagnostic performance of the proposed system with respect to a routine lead system. Differentiation between patients with angina pectoris and normal subjects.…”

Section: Composition Of the Seriessupporting

confidence: 60%

The Missing Waveform Information in the Orthogonal Electrocardiogram (Frank Leads)

Kornreich¹,

Block²,

Brismee³

1974

Circulation

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SUMMARYNine surface electrocardiograms recorded on the thoracic surface at fixed and identical locations in 412 individuals were found to account for the maximal useful waveform information available in each individual. In other words, nine waveforms were capable of resynthesizing any waveform recorded on their thoracic surface. These nine waveforms were then submitted to multivariate statistical procedures and their diagnostic performance compared to the Frank leads on which the same procedures were applied. Before the data were fed into the computer, all waveforms were time-normalized and divided into eight equal parts, yielding 72 variables and 24 variables for the nine lead system and the Frank leads, respectively, for each individual.In this paper we attempted to discriminate between normal subjects and patients with documented angina pectoris (typical history and positive coronary angiography); myocardial infarction was excluded in these patients. Only the resting QRS complex was considered. With the 9-lead system, keeping the specificity (true negatives) at 90%, the sensitivity (true positives) is 76%; with the Frank leads, the same specificity yielded a sensitivity of 49%. The repeatability of the results on new independent controls was also found very satisfactory.The discrimination between patients with angina pectoris on one hand and left ventricular hypertrophy and myocardial infarction on the other hand resulted in a performance level of 89% and 87%, respectively, for the 9-lead system. A good correlation was also found between the extent of the coronary lesions (number of coronary vessels involved) and the fraction of correctly diagnosed patients.The present study concluded that the retrieval of more complete surface information results in an evident improvement of the diagnostic performance of electrocardiography.

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Section: Composition Of the Seriessupporting

confidence: 60%

The Missing Waveform Information in the Orthogonal Electrocardiogram (Frank Leads)

Kornreich¹,

Block²,

Brismee³

1974

Circulation

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“…Little was known then about actual distributions of ECG findings in large populations, and the criteria proved to have a large observer variation. 2 Another serious shortcoming was the lack of information on the effect of constitutional variables on the ECG, which was later studied extensively. :", Thus, a code based on actual ECG data from large normal and abnormal populations that takes into account differences in ECG findings according to sex and race would be desirable.…”

mentioning

confidence: 99%

The electrocardiogram in epidemiologic investigations. A new classification system.

Pipberger¹,

Simonson²,

Lopez³

et al. 1982

Circulation

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SUMMARY A new coding system for ECG abnormalities was developed, based on Frank's orthogonal ECG leads. In contrast to other systems, such as the Minnesota Code (MC), the new system was based on data collected prospectively in a cooperative study of 5031 records. The records were classified solely on the basis of non-ECG information. A record sample from normal women was also available. The large data base allowed stratification of ECG criteria according to sex and race.ECG criteria were determined at two levels of sensitivity and specificity. Specificity was 80-100% at the first level and 90-90% at the second.The new system has fewer criteria than other codes, which leads to reduction of coding errors and coding time. For common problems in differential diagnosis, optional criteria were included. A computer program for automated coding was also developed.THE ECG is a standard tool in epidemiologic studies of cardiovascular disease. To report ECG findings in uniform, clearly defined terms, Blackburn et al.1 introduced the Minnesota Code (MC), which has been widely used.The original MC was based on the more reliable and generally accepted diagnostic criteria known at that time (1960). Little was known then about actual distributions of ECG findings in large populations, and the criteria proved to have a large observer variation.2 Another serious shortcoming was the lack of information on the effect of constitutional variables on the ECG, which was later studied extensively.:", Thus, a code based on actual ECG data from large normal and abnormal populations that takes into account differences in ECG findings according to sex and race would be desirable. In the present study, we attempted to take these factors int-o consideration.Corrected orthogonal leads have contributed substantially to a better understanding of ECG lead performance and are being used in most of the larger epidemiologic studies. One major advantage of these leads is the substantial data reduction (12 may not be in agreement with the original Frank lead data.The availability of a large documented ECG library was significant in selecting the Frank lead system for the new code. Based on standardized, ECG-independent clinical information,9 '7 this library was developed through a Cooperative Study of the Veterans Administration. Eight hospitals participated.To reduce coding time and coding errors, the new system was kept as simple and convenient as possible. Material and MethodsThe samples used to develop the code are listed in table 1. The selection criteria have been described in deta'l,9-17 but a brief summary will be given here.The records from normal subjects9' 17 were obtained from 1049 adult men and 450 adult women. The age and race distributions of these subjects are shown in figure 1. All patients had a complete history, physical examination and routine laboratory tests. All subjects who had diseases that frequently predispose to cardiovascular disease (diabetes mellitus, pulmonary disease, renal disease, hypertension, anemia and collagen ...

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“…This corresponds well to the previously reported error rate in this program.12 At least one study has cast doubt upon whether human readers can maintain a comparably low error rate. 21 Diagnostic disagreements based upon criteria differences occurred in 20.1% of our cases ( fig. 10).…”

Section: Discussionmentioning

confidence: 76%

A Method for Evaluating Computer Programs for Electrocardiographic Interpretation

et al. 1974

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The programs studied in these three reports were chosen for two reasons: first, they were available to the National Institutes of Health, and second, they could be implemented on computers readily available to the National Institutes of Health. However the methods for evaluation reported here could be used at any other institution and are not dependent upon a specific program or computer system. The authors have a continuing interest in automated ECG analysis and may select for study additional programs, the treatment of ECG analysis of which differs significantly from the programs reported here. The results of these studies will be submitted for publication in an appropriate journal. Conclusions drawn from these studies including the present three reports represent the considered opinions of the authors and do not represent any official policy of the Department of Health, Education and Welfare. SUMMARYA method for evaluating computer programs for electrocardiographic interpretation is described. This method allows a clinician to judge the usefulness of a program for his specific setting and needs. The method requires a significant proportion and variety of abnormal tracings, the application of specific fixed criteria, and the separation of disagreements between the computer program and the clinician into those resulting from criteria differences and those resulting from programming errors, viz., pattern recognition failures, mismeasurements, and/or deficient program logic. When applied to the experimental IBM program 1971, staff cardiologists found essential agreement with the program's results in 76% of 1150 unselected tracings. Clinically significant disagreements based strictly on the application of different criteria occurred in 20% of the tracings, whereas disagreements based on program errors were found in only 4%. Although this program requires some system of human overview and quality checking, its potential for clinical implementation is worthy of consideration.

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Diagnostic accuracy of the vectorcardiogram and electrocardiogram

Cited by 118 publications

References 24 publications

The Missing Waveform Information in the Orthogonal Electrocardiogram (Frank Leads)

The Missing Waveform Information in the Orthogonal Electrocardiogram (Frank Leads)

The electrocardiogram in epidemiologic investigations. A new classification system.

A Method for Evaluating Computer Programs for Electrocardiographic Interpretation

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