Muhlestein Joseph Boone, Le Viet, Albert David, Moreno Fidela Ll, Anderson Jeffrey L, Yanowitz Frank, Vranian Robert B, Barsness Gregory W, Bethea Charles F, Severance Harry W, Ramo Barry, Pierce John, Barbagelata Alejandro, Muhlestein Joseph Brent
Intermountain Heart Institute, Salt Lake City, UT; The University of Utah, Department of Internal Medicine, Salt Lake City, UT.
Intermountain Heart Institute, Salt Lake City, UT.
J Electrocardiol. 2015 Mar-Apr;48(2):249-59. doi: 10.1016/j.jelectrocard.2014.11.005. Epub 2014 Dec 27.
12-lead ECG is a critical component of initial evaluation of cardiac ischemia, but has traditionally been limited to large, dedicated equipment in medical care environments. Smartphones provide a potential alternative platform for the extension of ECG to new care settings and to improve timeliness of care.
To gain experience with smartphone electrocardiography prior to designing a larger multicenter study evaluating standard 12-lead ECG compared to smartphone ECG.
6 patients for whom the hospital STEMI protocol was activated were evaluated with traditional 12-lead ECG followed immediately by a smartphone ECG using right (VnR) and left (VnL) limb leads for precordial grounding. The AliveCor™ Heart Monitor was utilized for this study. All tracings were taken prior to catheterization or immediately after revascularization while still in the catheterization laboratory.
The smartphone ECG had excellent correlation with the gold standard 12-lead ECG in all patients. Four out of six tracings were judged to meet STEMI criteria on both modalities as determined by three experienced cardiologists, and in the remaining two, consensus indicated a non-STEMI ECG diagnosis. No significant difference was noted between VnR and VnL.
Smartphone based electrocardiography is a promising, developing technology intended to increase availability and speed of electrocardiographic evaluation. This study confirmed the potential of a smartphone ECG for evaluation of acute ischemia and the feasibility of studying this technology further to define the diagnostic accuracy, limitations and appropriate use of this new technology.
12导联心电图是心脏缺血初始评估的关键组成部分，但传统上仅限于医疗环境中的大型专用设备。智能手机为将心电图扩展到新的护理环境并提高护理及时性提供了一个潜在的替代平台。
在设计一项更大规模的多中心研究以评估标准12导联心电图与智能手机心电图之前，积累智能手机心电图方面的经验。
对6例激活医院ST段抬高型心肌梗死（STEMI）方案的患者，先用传统12导联心电图进行评估，随后立即使用右（VnR）和左（VnL）肢体导联进行胸前接地的智能手机心电图检查。本研究使用了AliveCor™心脏监测仪。所有心电图记录均在导管插入术之前或血管再通后仍在导管插入实验室时进行。
在所有患者中，智能手机心电图与金标准12导联心电图具有极好的相关性。由三位经验丰富的心脏病专家判断，六份心电图记录中有四份在两种检查方式下均符合STEMI标准，其余两份经共识确定为非STEMI心电图诊断。VnR和VnL之间未发现显著差异。
基于智能手机的心电图是一项有前景的、正在发展的技术，旨在提高心电图评估的可及性和速度。本研究证实了智能手机心电图用于评估急性缺血的潜力，以及进一步研究该技术以确定其诊断准确性、局限性和适当应用的可行性。
