Herzzentrum, Segeberger Kliniken GmbH, Bad Segeberg, Germany.
Clin Res Cardiol. 2012 Sep;101(9):727-36. doi: 10.1007/s00392-012-0452-2. Epub 2012 Apr 7.
Cardiogoniometry (CGM) is a novel electrocardiac method utilising computer-assisted three-dimensional information on cardiac potentials.
To investigate the potential of CGM in discriminating non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and relevant coronary stenosis upon hospital admission by prospectively comparing its sensitivity, specificity and accuracy against those of a single troponin test and a 12-lead ECG performed on admission
A multicenter prospective observational trial.
Eight interventional cardiac centres in Germany.
A cohort of 216 patients (mean age 67 years, 34.7 % female) who presented with acute chest pain or dyspnoea without ST-segment elevation and were scheduled for coronary angiography within 72 h of admission.
Pre-angiography screening by CGM, troponin test, 12-lead ECG MAIN OUTCOME MEASURES: ECG, troponin and CGM on admission compared with final diagnosis of NSTE-ACS or relevant diameter stenosis ≥70 % verified by an independent review board and an angiographic core laboratory.
NSTE-ACS was finally confirmed in 162 cases, whereas the remaining 54 cases without proof of NSTE-ACS served as controls. Diagnostic sensitivity for NSTE-ACS was 28, 50 and 69 % and specificity 78, 96 and 54 % for first ECG, serial troponin and first CGM, respectively. Accuracy was 40, 62 and 65 %. The sensitivity of the tests to detect relevant coronary stenosis (n = 126) was 32, 53 and 74 %, respectively. The sensitivity of CGM to detect NSTE-ACS (65 %) or relevant stenosis (71 %) was high even in patients with normal troponin and ECG.
CGM can detect NSTE-ACS at first medical contact. CGM in conjunction with traditional markers, 12-lead ECG and troponin may effectively aid early decision making in patients presenting with acute chest pain.
心脏测振术（CGM）是一种利用计算机辅助获取心脏电位三维信息的新型心电图方法。
通过前瞻性比较入院时单次肌钙蛋白检测、入院时 12 导联心电图与 CGM 的敏感性、特异性和准确性，探讨 CGM 对入院时非 ST 段抬高型急性冠状动脉综合征（NSTE-ACS）和相关冠状动脉狭窄的鉴别诊断价值。
多中心前瞻性观察性试验。
德国 8 家介入性心脏中心。
入选 216 例因急性胸痛或呼吸困难就诊且无 ST 段抬高、入院 72 h 内行冠状动脉造影的患者（平均年龄 67 岁，34.7%为女性）。
入院前 CGM、肌钙蛋白检测、12 导联心电图筛查。
入院时心电图、肌钙蛋白和 CGM 与最终诊断为 NSTE-ACS 或经独立审查委员会和血管造影核心实验室证实的≥70%直径狭窄的相关性。
162 例最终确诊为 NSTE-ACS，其余 54 例未确诊 NSTE-ACS 的患者作为对照组。首次心电图、连续肌钙蛋白和首次 CGM 对 NSTE-ACS 的诊断敏感性分别为 28%、50%和 69%，特异性分别为 78%、96%和 54%。准确性分别为 40%、62%和 65%。检测相关冠状动脉狭窄（n=126）的敏感性分别为 32%、53%和 74%。即使在肌钙蛋白和心电图正常的患者中，CGM 对 NSTE-ACS（65%）或相关狭窄（71%）的检测敏感性也较高。
CGM 可在首次就诊时检测出 NSTE-ACS。CGM 联合传统标志物、12 导联心电图和肌钙蛋白可能有助于急性胸痛患者的早期决策。
