Smartphone based 12 lead ECG as decision support in STEMI: a prospective, cross sectional study, non-randomised, single blinded and single-center study
Keywords:STEMI, Smartphone, Specificity, Accuracy, Validation, Sensitivity
Background: When a severe heart attack called a ST segment elevation myocardial infarction (STEMI) is not treated, heart muscle is killed per minute. Hence, early detection and treatment are essential for patient survival. The objectives of this study were to evaluate the accuracy for detection of (a) the ST elevation myocardial infarction of smartphone 12 lead ECG system in comparison to 12 lead gold standard hospital ECG machine; and (b) classification of STEMI in smartphone ECG and hospital ECG.
Methods: This prospective, cross sectional study, non-randomised, single blinded and single-center study was carried out at Shri Mahant Indresh Hospital (SMIH), Dehradun, Uttarakhand, India from 30 May 2022 to 17 January 2023. All patients (n=154) with chest pain, shortness of breath, palpitation under the observations before and after the Percutaneous coronary intervention (PCI) like Coronary angioplasty, bypass surgery were enrolled from Critical care unit (CCU) and intensive critical care unit (ICCU).
Results: Mean age (SD) was 53.90±11.7 years. The male gender (83.12%) shows the maximum frequency than female gender. True positive cases derived from confusion matrix for 12 lead standard ECG and smartphone ECG in comparison to cardiologist diagnosis was 113 as compared to 129 from 12 lead Gold standard. Sensitivity of smartphone Spandan ECG (87.5%) was comparable to gold standard 12 lead ECG (98.4%). And, specificity and PPV of smartphone Spandan ECG was recorded to be better than gold standard 12 Lead ECG. STEMI was detected correctly in 132 (86.3%) cases and 141 (80.85%) cases by smartphone ECG and 12 lead Gold standard, respectively.
Conclusions: Spandan ECG device scored a high accuracy and sensitivity. The overall accuracy of smartphone ECG in detecting the STEMI increased by 5.45%, i.e. the significance rise in accuracy of computer interpretation when compared to the cardiologists’ diagnosis.
Kamga P, Mostafa R, Zafar S. The Use of Wearable ECG Devices in the Clinical Setting: a Review. Curr Emerg Hosp Med Rep. 2022;10(3):67-72.
Vardas PE, Asselbergs FW, Smeden M, Friedman P. The year in cardiovascular medicine 2021: digital health and innovation. Eur Heart J. 2022;43(4):271-9.
Choi YJ, Park MJ, Ko Y, Soh MS, Kim HM, Kim CH, et al. Artificial intelligence versus physicians on interpretation of printed ECG images: Diagnostic performance of ST-elevation myocardial infarction on electrocardiography. Int J Cardiol. 2022;363:6-10.
Muhlestein JB, Le V, Albert D, Moreno FL, Anderson JL, Yanowitz F, et al. Smartphone ECG for evaluation of STEMI: results of the ST LEUIS Pilot Study. J Electrocardiol. 2015;48(2):249-59.
Bladin CF, Bagot KL, Vu M, Kim J, Bernard S, Smith K, et al. Real-world, feasibility study to investigate the use of a multidisciplinary app (Pulsara) to improve prehospital communication and timelines for acute stroke/STEMI care. BMJ Open. 2022;12(7):e052332.
Liu ES, Hung CC, Chiang CH, Tsai YC, Fu YJ, Ko YL, et al. Quality care in ST-segment elevation myocardial infarction. J Chin Med Assoc. 2022;85(3):268-75.
Muhlestein JB, Bethea CF, Severance HW, Barbagelata A, Mentz RJ, Albert D, et al. Determination of the Diagnostic Accuracy of a Mobile Smartphone ECG Device Compared to a Standard 12-Lead ECG for Evaluation of ST-Segment Elevation Myocardial Infarction (STEMI). Primary Results of the ST LEUIS International Multicenter Study. Circulation. 2018;138(1):A11623.
Barbagelata A, Bethea CF, Severance HW, Mentz RJ, Albert D, Barsness GW, et al. Smartphone ECG for evaluation of ST-segment elevation myocardial infarction (STEMI): Design of the ST LEUIS International Multicenter Study. J Electrocardiol. 2018;51(2):260-4.
Conduce A, Sciacca DD, Sbrenni S. Impact of wireless technologies on public health: a literature review. Int J Med Eng Inform. 2022;14(2):190-211.
Chandola N, Singh Y, Mahajan S, Garg S, Bansal B. Validation Study of a Derived 12 Lead Reconstructed ECG Interpretation in a Smartphone-Based ECG Device. ICT Systems and Sustainability: Proceedings of ICT4SD. Singapore: Springer Nature; 2022: 43-51.
Jothiaruna N, Leema AA. Meta-Analysis to Prognosis Myocardial Infarction Using 12 Lead ECG. High Performance Computing and Networking: Select Proceedings of CHSN 2021. Singapore: Springer Singapore; 2022: 473-488.
Suhaim SJ, Ali I. A Portable Android Based ECG System for Long-Time Heart Monitoring. IEEE: Delhi Section Conference; 2022: 1-6.
Yoo S, Chang H, Kim T, Yoon H, Hwang S, Sin T, et al. Timeliness of Single-Patch 12-Lead Electrocardiography for Patients with Chest Pain at the Emergency Department. Stud Health Technol Inform. 2022;294:930-4.
Muhlestein JB, Anderson JL, Bethea CF, Severance HW, Mentz RJ, Barsness GW, et al. Feasibility of combining serial smartphone single-lead electrocardiograms for the diagnosis of ST-elevation myocardial infarction. Am Heart J. 2020;221:125-35.
Bond R, Finlay D, Guldenring D, Kennedy A, McLaughlin J. Limitations of the smartphone based single ECG-lead evaluation of STEMI. International Society for Computerised Electrocardiology. Amsterdam: Elsevier; 2018: 859.
Kini A, Garcia H, Springer B, Vengrenyuk A, Pineda D, Bastone J, et al. A mobile application for STEMI care optimization: pilot implementation project report. European Heart J Digital Health. 2022;3(4):2823.
Wegner FK, Eckardt L. Smartphone-based ECG devices: Beyond atrial fibrillation screening. Eur J Intern Med. 2022;95:111-2.
Emmett A, Kent B, James A, March-McDonald J. Experiences of health professionals towards using mobile electrocardiogram (ECG) technology: A qualitative systematic review. J Clin Nurs. 2022.
Kuznetsova N, Gubina A, Sagirova Z, Dhif I, Gognieva D, Melnichuk A, et al. Left Ventricular Diastolic Dysfunction Screening by a Smartphone-Case Based on Single Lead ECG. Clin Med Insights Cardiol. 2022;16:11795468221120088.
Gill S, Bunting KV, Sartini C, Cardoso VR, Ghoreishi N, Uh HW, et al. Smartphone detection of atrial fibrillation using photoplethysmography: a systematic review and meta-analysis. Heart. 2022;108(20):1600-7.