Department of Anesthesiology, Centre for Cancer and Organ Diseases, Rigshospitalet Copenhagen University Hospital, Blegdamsvej 9, 2200 Copenhagen, Denmark.
Department of Cardiology, Rigshospitalet Copenhagen University Hospital, 2100 Copenhagen, Denmark.
Sensors (Basel). 2023 Mar 9;23(6):2962. doi: 10.3390/s23062962.
Wearable wireless electrocardiographic (ECG) monitoring is well-proven for arrythmia detection, but ischemia detection accuracy is not well-described. We aimed to assess the agreement of ST-segment deviation from single- versus 12-lead ECG and their accuracy for the detection of reversible ischemia. Bias and limits of agreement (LoA) were calculated between maximum deviations in ST segments from single- and 12-lead ECG during Rb PET-myocardial cardiac stress scintigraphy. Sensitivity and specificity for reversible anterior-lateral myocardial ischemia detection were assessed for both ECG methods, using perfusion imaging results as a reference. Out of 110 patients included, 93 were analyzed. The maximum difference between single- and 12-lead ECG was seen in II (-0.019 mV). The widest LoA was seen in V5, with an upper LoA of 0.145 mV (0.118 to 0.172) and a lower LoA of -0.155 mV (-0.182 to -0.128). Ischemia was seen in 24 patients. Single-lead and 12-lead ECG both had poor accuracy for the detection of reversible anterolateral ischemia during the test: single-lead ECG had a sensitivity of 8.3% (1.0-27.0%) and specificity of 89.9% (80.2-95.8%), and 12-lead ECG a sensitivity of 12.5% (3.0-34.4%) and a specificity of 91.3% (82.0-96.7%). In conclusion, agreement was within predefined acceptable criteria for ST deviations, and both methods had high specificity but poor sensitivity for the detection of anterolateral reversible ischemia. Additional studies must confirm these results and their clinical relevance, especially in the light of the poor sensitivity for detecting reversible anterolateral cardiac ischemia.
可穿戴式无线心电图 (ECG) 监测在心律失常检测方面已得到充分证实，但缺血检测的准确性尚未得到充分描述。我们旨在评估单导联与 12 导联 ECG 中 ST 段偏移的一致性及其对可逆性缺血检测的准确性。在放射性核素心肌灌注成像负荷试验中，计算单导联和 12 导联 ECG 中 ST 段最大偏移之间的偏倚和界限（LoA）。使用灌注成像结果作为参考，评估两种 ECG 方法对前外侧可逆性心肌缺血检测的敏感性和特异性。110 例患者中，93 例进行了分析。单导联和 12 导联 ECG 的最大差异出现在 II 导联（-0.019 mV）。V5 导联的 LoA 最宽，上界为 0.145 mV（0.118 至 0.172），下界为-0.155 mV（-0.182 至-0.128）。24 例患者出现缺血。在试验过程中，单导联和 12 导联 ECG 对前外侧可逆性缺血的检测准确性均较差：单导联 ECG 的敏感性为 8.3%（1.0%至 27.0%），特异性为 89.9%（80.2%至 95.8%），12 导联 ECG 的敏感性为 12.5%（3.0%至 34.4%），特异性为 91.3%（82.0%至 96.7%）。总之，ST 段偏移的一致性在预设的可接受标准内，两种方法的特异性均较高，但对前外侧可逆性缺血的敏感性较差。需要进一步的研究来证实这些结果及其临床意义，特别是考虑到对前外侧可逆性心脏缺血检测的敏感性较差。
