Comparative Analysis of the Diagnostic Effectiveness of SATRO ECG in the Diagnosis of Ischemia Diagnosed in Myocardial Perfusion Scintigraphy Performed Using the SPECT Method.

Łukasz Jerzy Janicki,Mateusz Nowotarski,Mirosław Dziuk,Jerzy Stanisław Janicki,Wiesław Leoński,Ryszard Piotrowicz

doi:10.3390/diagnostics12020297

Abstract

There is a great need for early diagnosis of ischemic heart disease (IHD), the most common cause of which is haemodynamic disorders caused mainly by obstructive atherosclerosis of the coronary arteries. The diagnosis of IHD is usually made with the use of functional tests, which include resting ECG (R) or examination of significant perfusion disorders during exercise using the SPECT method. Despite the fact that the ECG (R) test is commonly used in cardiological diagnostics, it has a limited diagnostic value, especially in people with a low probability of coronary artery disease (CAD). In order to increase the effectiveness of the ECG (R) examination, SATRO ECG software, based on the single fibres heart activity model (SFHAM), was used to evaluate the electrocardiograms. The introduction of new classifiers from the available medical data to the analysis made it possible to evaluate the diagnostic efficacy of SATRO ECG (TOT) in predicting significant perfusion disorders in the exercise SPECT (TOT 2). These disorders are most often caused by obstructive atherosclerosis of the coronary arteries, which is the main cause of CAD. The database of 316 patients (219 men and 97 women, aged 57 ± 10 years) was analyzed using resting and stress ECG, perfusion scintigraphy performed using the SPECT method, and SATRO ECG analysis. The diagnostic efficacy parameters of SATRO ECG (TOT) in predicting significant perfusion abnormalities in the exercise-induced SPECT (TOT 2) study were: sensitivity, 99%; specificity, 91%; concordance, 96%; and positive, 96%, and negative, 97%, predictive values. The Kappa–Cohen coefficient was 0.92, and the statistical significance coefficient was p < 0.001. These results indicate a statistically significant agreement in the diagnosis of IHD in both diagnostic methods used.

Highlights

The method of imaging the variability of the electric potential generated by the heart is widely used in cardiological diagnostics as a functional test, e.g., to diagnose ischemic heart disease (IHD), the most common cause of which involves haemodynamic disorders caused mainly by obstructive coronary artery disease (CAD) [1,2]
The diagnostic efficiency of the ECG is unsatisfactory, because the current method of analyzing the measured potential does not allow one to recognize both the process of discrete stimulation of individual areas of the heart muscle (HM) and the potential occurring during the depolarization of individual parts of the effective HM fiber representing a specific area of HM [3]
In the current ECG studies, it is difficult to determine the effect on the parameters of the potential of factors related to, for example, permanent loss of HM cell potential, disturbances in the intraventricular conduction system (ICS), or HM inflammation [4,5], which significantly reduces the effectiveness of IHD diagnosis using this tool

Summary

Introduction

The method of imaging the variability of the electric potential generated by the heart is widely used in cardiological diagnostics as a functional test, e.g., to diagnose ischemic heart disease (IHD), the most common cause of which involves haemodynamic disorders caused mainly by obstructive coronary artery disease (CAD) [1,2]. In the current ECG studies, it is difficult to determine the effect on the parameters of the potential of factors related to, for example, permanent loss of HM cell potential, disturbances in the intraventricular conduction system (ICS), or HM inflammation [4,5], which significantly reduces the effectiveness of IHD diagnosis using this tool. The diagnosis of IHD often results from the assessment of the parameters of the potential associated with repolarization [6,7,8,9]. This test has limited diagnostic value, especially if the ECG was performed during the pain-free period in people with a low probability of developing CAD. ECG examination is common and easy to perform, increasing its diagnostic effectiveness in the diagnosis of IHD is extremely important for general practitioners and cardiologists

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Discussion

Conclusion