The Missing Waveform Information in the Orthogonal Electrocardiogram (Frank Leads): III. Computer Diagnosis of Angina Pectoris from “Maximal’ QRS Surface Waveform Information At Rest

Nine 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.

[1]  P. Vokonas,et al.  A quantitative clinical index for the diagnosis of symptomatic coronary-artery disease. , 1972, The New England journal of medicine.

[2]  Angina Without Coronary Disease (sic) , 1970, Circulation.

[3]  M. Prinzmetal,et al.  Myocardial ischemia. Nature of ischemic electrocardiographic patterns in the mammalian ventricles as determined by intracellular electrographic and metabolic changes. , 1961, The American journal of cardiology.

[4]  J A ABILDSKOV,et al.  The Relation of Precordial and Orthogonal Leads , 1963, Circulation.

[5]  T Y YOUNG,et al.  ON THE REPRESENTATION OF ELECTROCARDIOGRAMS. , 1963, IEEE transactions on bio-medical engineering.

[6]  J. Boineau,et al.  Comparison of Human Ventricular Activation with a Canine Model in Chronic Myocardial Infarction , 1971, Circulation.

[7]  B. Taccardi,et al.  Distribution of Heart Potentials on the Thoracic Surface of Normal Human Subjects , 1963, Circulation research.

[8]  B. Taccardi,et al.  Chest maps of heart potentials in right bundle branch block. , 1969, Journal of electrocardiology.

[9]  R A Bruce,et al.  Computed ST forces of Frank and bipolar exercise electrocardiograms. , 1969, American heart journal.

[10]  R A Bruce,et al.  Introductory report on ST responses to maximal exercise, quantitative measurements, time course and relationships. , 1969, Malattie cardiovascolari.

[11]  M. Lynn,et al.  A Study of the Human Heart as a Multiple Dipole Electrical Source: I. Normal Adult Male Subjects , 1969, Circulation.

[12]  W F ENOS,et al.  Coronary disease among United States soldiers killed in action in Korea; preliminary report. , 1953, Journal of the American Medical Association.

[13]  G. Friesinger,et al.  Correlation of Electrocardiographic Studies and Arteriographic Findings with Angina Pectoris , 1972, Circulation.

[14]  D. B. Geselowitz,et al.  Multipole Representation for an Equivalent Cardiac Generator , 1960, Proceedings of the IRE.

[15]  J. Mcnamara,et al.  Coronary artery disease in combat casualties in Vietnam. , 1971, JAMA.

[16]  W. Abelmann,et al.  Clinicopathologic Correlations in Coronary Atherosclerosis , 1963 .

[17]  E. W. Reynolds,et al.  High‐Frequency Components in the Electrocardiogram: A Comparative Study of Normals and Patients with Myocardial Disease , 1967, Circulation.

[18]  THE LIMITS OF INFORMATION IN THE VECTORCARDIOGRAM: COMPARATIVE RESYNTHESIS OF BODY SURFACE POTENTIALS WITH DIFFERENT LEAD SYSTEMS. , 1964, American heart journal.

[19]  H V PIPBERGER,et al.  Correlation of clinical information in the standard 12-lead ECG and in a corrected orthogonal 3-lead ECG. , 1961, American heart journal.

[20]  R. Barr,et al.  Cardiac Potentials on Body Surface of Infants with Anomalous Left Coronary Artery (Myocardial Infarction) , 1967, Circulation.

[21]  E E Eddleman,et al.  Computer analysis of the orthogonal electrocardiogram and vectorcardiogram in 1,002 patients with myocardial infarction. , 1971, American heart journal.

[22]  W. Abelmann,et al.  Clinicopathologic Correlations in Coronary Atherosclerosis: Four Hundred Thirty Patients Studied with Postmortem Coronary Angiography , 1963, Circulation.

[23]  M. P. Judkins,et al.  A comparison of hypoxemia and exercise electrocardiography in coronary artery disease. Diagnostic precision of the methods correlated with coronary angiography. , 1968, American heart journal.

[24]  L. Horan,et al.  The Anatomic Basis for High‐Frequency Components in the Electrocardiogram , 1969, Circulation.

[25]  J. .. Abildskov,et al.  FURTHER STUDIES OF THE ELECTROCARDIOGRAPHIC EFFECTS OF EXPERIMENTAL MYOCARDIAL LESIONS. , 1965, American heart journal.

[26]  R Gorlin,et al.  The anginal syndrome associated with normal coronary arteriograms. Report of a six year experience. , 1973, The American journal of medicine.

[27]  P. Zoll,et al.  Angina pectoris: A clinical and pathologic correlation , 1951 .

[28]  W. C. Elliott,et al.  The anginal syndrome with normal coronary arteriography. , 1967, Transactions of the Association of American Physicians.

[29]  R. Selvester,et al.  New quantitative vectorcardiographic criteria for the detection of unsuspected myocardial infarction in diabetics. , 1968, American heart journal.

[30]  H V Pipberger,et al.  Computer analysis of the orthogonal electrocardiogram in pulmonary emphysema. , 1970, The American journal of cardiology.

[31]  J Dow,et al.  Coronary arteriography. , 1969, Guy's Hospital reports.

[32]  R. Gorlin.  Evaluation of patients with coronary artery disease. , 1973, Progress in cardiovascular diseases.

[33]  E. Simonson,et al.  The effect of age on the electrocardiogram. , 1972, The American journal of cardiology.

[34]  D. Geselowitz,et al.  High-frequency components in the electrocardiograms of normal subjects and of patients with coronary heart disease. , 1961, American heart journal.

[35]  H Kagiwada,et al.  A digital computer model of the vectorcardiogram with distance and boundary effects: simulated myocardial infarction. , 1967, American heart journal.

[36]  E. Simonson,et al.  Differentiation between normal and abnormal in electrocardiography , 1962 .

[37]  P. Langner,et al.  The relative significance of high-frequency and low-frequency notching in the electrocardiogram. , 1966, American heart journal.

[38]  H. Pipberger,et al.  Computer classifications of electrocardiograms. , 1967, Computers and biomedical research, an international journal.

[39]  H. Baltaxe,et al.  Coronary Angiography: Its Role in the Management of the Patient with Angina Pectoris , 1972, Circulation.

[40]  G. Friesinger,et al.  Prognostic significance of coronary arteriography. , 1970, Transactions of the Association of American Physicians.

[41]  D A BRODY,et al.  Principal Factor Waveforms of the Thoracic QRS Complex , 1964, Circulation research.

[42]  F. Cutts,et al.  Chest Pain with Inverted T Waves, Predominantly in Precordial Leads, as the Only Electrocardiographic Abnormality , 1957, Circulation.

[43]  Harold T. Dodge,et al.  Quantitative Angiocardiography: I. The Normal Left Ventricle in Man , 1966, Circulation.

[44]  J. Edwards,et al.  Pathology of Angina Pectoris , 1972, Circulation.

[45]  R. E. Mason,et al.  Multiple‐Lead Exercise Electrocardiography: Experience in 107 Normal Subjects and 67 Patients with Angina Pectoris, and Comparison with Coronary Cinearteriography in 84 Patients , 1967, Circulation.

[46]  L. Horan,et al.  Localization of the Site of Myocardial Scarring in Man by High‐Frequency Components , 1969, Circulation.

[47]  H. Pipberger,et al.  The Corrected Orthogonal Electrocardiogram and Vectorcardiogram in 510 Normal Men (Frank Lead System) , 1964, Circulation.

[48]  R C Barr,et al.  Interpretation of Isopotential Surface Maps in Patients with Ostium Primum and Secundum Atrial Defects , 1970, Circulation.

[49]  P. Scanlon,et al.  Accelerated Angina Pectoris: Clinical, Hemodynamic, Arteriographic, and Therapeutic Experience in 85 Patients , 1973, Circulation.

[50]  A. Ekmekci,et al.  Angina pectoris. V. Giant R and receding S wave in myocardial ischemia and certain nonischemic conditions. , 1961, The American journal of cardiology.

[51]  W. Roberts.  Does Thrombosis Play a Major Role in the Development of Symptom‐Producing Atherosclerotic Plaques? , 1973 .

[52]  P. Vokonas,et al.  Postexercise Electrocardiogram in Patients With Abnormal Resting Electrocardiograms , 1971, Circulation.

[53]  Noboru Okamoto,et al.  Diagnostic accuracy of the vectorcardiogram and electrocardiogram: A cooperative study , 1966 .

[54]  H. Dodge,et al.  The use of biplane angiocardigraphy for the measurement of left ventricular volume in man. , 1960, American heart journal.

[55]  H. Blackburn,et al.  Serial electrocardiographic changes in myocardial infarction. , 1972, The American journal of cardiology.

[56]  H. Pipberger,et al.  Computer Diagnosis of Biventricular Hypertrophy from the Orthogonal Electrocardiogram , 1969, Circulation.

[57]  H. Dodge,et al.  A Method for Determining Left Ventricular Mass in Man , 1964, Circulation.

[58]  H V Pipberger,et al.  Analysis of the Orthogonal Electrocardiogram and Vectorcardiogram in Ventricular Conduction Defects With and Without Myocardial Infarction , 1969, Circulation.

[59]  G. Burch,et al.  A Correlative Study of Postmortem, Electrocardiographic, and Spatial Vectorcardiographic Data in Myocardial Infarction , 1958, Circulation.

[60]  M. Lynn,et al.  A Study of the Human Heart as a Multiple Dipole Electrical Source: II. Diagnosis and Quantitation of Left Ventricular Hypertrophy , 1969, Circulation.

[61]  G. S. Herman-Giddens,et al.  Selection of the number and positions of measuring locations for electrocardiography. , 1971, IEEE transactions on bio-medical engineering.

[62]  R. Barr,et al.  Genesis of Body Surface Potentials in Varying Types of Right Ventricular Hypertrophy , 1968, Circulation.

[63]  L. T. Sheffield,et al.  Comparison of submaximal exercise ECG test with coronary cineangiocardiogram. , 1970, Annals of internal medicine.

[64]  F Kornreich,et al.  II. Diagnosis of Left Ventricular Hypertrophy and Myocardial Infarction from “Total’ Surface Waveform Information , 1973 .

[65]  H. Levine,et al.  Subendocardial Infarction: Report of Six Cases and Critical Survey of the Literature , 1950, Circulation.