Optimal lead subsets for reconstruction of QRS and ST-T in 35-lead precordial maps.

ABSTRACT

Precordial maps have been used for some 15 years to estimate the extent of myocardial injury in patients with acute anterior or lateral wall infarction. Estimates have been based on various QRS- and ST-T-derived parameters, including amplitude sum of ST elevations. Application of the electrodes, commonly 35, is cumbersome and time-consuming with the critically ill. A subset of 5 or 7 selected leads can be applied instead, and the remaining leads calculated from that subset with minimal loss of QRS and ST-T information. Maps were recorded from 100 patients within 72 hours of onset of anterior or lateral infarct. Optimal lead subsets for QRS and ST-T feature extraction were found by the sequential selection method of Lux. Subsets numbering between 2 and 15 leads were derived, with their lead-transform coefficients. Measures to estimate goodness of fit for reconstructed leads included correlations, error-to-signal ratios and root-mean-square errors. These measures were calculated separately over the QRS and ST-T complexes. Reconstructions from a 7-lead subset had a mean 0.92 correlation with ST-T in the original leads and root-mean-square error of only 0.04 mV. Sum of ST elevation differed by only 2% between original leads and reconstructions based on 5 or more leads. To confirm repeatability, lead-transform coefficients were also calculated from a training population of 50 patients and applied to the maps of the other 50.