Chest Pain and Acute Coronary Syndrome (ACS)
Worried about a Myocardial Infarction? Cardiovascular Diseases are the Main Cause of Mortality in Europe. They Account for Approximately 40% of Deaths.
In Europe, every day approximately 40,000 people are admitted to hospital with a suspected acute coronary syndrome (ACS). Coronary artery disease (CAD) is the main cause of death for people before the age of 65 in Europe, accounting for over 803,000 deaths each year. CAD is the cause of death for 31% of deaths before the age of 65 in men and 29% of deaths before the age of 65 in women. One in eight men (12%) and one in 20 women (5%) die from CAD before the age of 65.* The diagnosis of myocardial infarction is confirmed in up to 10% of the cases. Over 30% of patients suffering from myocardial infarction die before they reach the hospital. In another 30% of the cases, the clinical course is completely asymptomatic – an observation made particularly often in diabetics and in the very elderly.
* European cardiovascular disease statistics 2008
Early and Reliable Detection of Myocardial Infarction?
The treatment of acute myocardial infarctions has significantly improved in recent years. As a result, hospital mortality has dropped significantly. A critical factor in the survival of patients with acute coronary syndrome is the admittance to an appropriate hospital and the effective use of available resources in the modern Chest Pain Units. Risk stratification of patients with chest pain is essential before performing any invasive procedures to confirm the initial diagnosis.* In the absence of any specific ECG changes or if no elevation in myocardial markers is detected, more elaborate and comprehensive diagnostics are required to confirm or rule out cardiac causes. In clinical practice, the benefits for both medical professionals and patients are significant when reliable diagnostic information can be obtained rapidly and straightforward.
* ACS Guidelines
Cardiogoniometry Provides Additional Diagnostic Information Fast, Aiding the Medical Professional and the Patient.
Diagnosing Chest Pain is a Multi-Dimensional Task
Due to its typical immediate changes in an ECG, an ST-elevation myocardial infarction (STEMI) is a clearly recognizable type of infarction. Patients suffering an STEMI are immediately treated following current guidelines. If, however, the patient’s 12 Lead Rest ECG appears normal or is inconclusive, they may have a non-ST segment elevation myocardial infarction (NSTEMI) or unstable angina pectoris (UAP). These patients are part of a particular risk group. In recent years, cardiac troponin has become the preferred biomarker for diagnosing NSTEMI.
But, How many Patients Admitted to a Chest Pain Unit Can be Classified Clearly by ECG Findings or Troponin Levels?
Out of 100 patients, fewer than 10% have a STEMI at the time of admission, up to 15% have a NSTEMI and at least 20% have UAP. More than half of the patients are transferred or discharged.* With no more than 10% of the patients being identified based on pathological ECG changes and only another 15% by an increase in cardiac markers, that leaves over 75% for whom a diagnosis is based on normal 12 Lead Rest ECG and troponin findings.
* Initial findings of the German CPU Registry, Feb. 2010, Munich
Chest Pain Diagnosis
Particularly in cases, where ECG findings were non-specific, an acute coronary syndrome can now be detected at an earlier stage, using Cardiogoniometry as an additional diagnostic method. In prospective studies, enverdis’ Cardiogoniometry method demonstrated a high sensitivity of 64 % and a specificity of 82 %*. The findings obtained by a Cardiogoniometry test can therefore greatly contribute to a faster and more reliable detection of acute coronary syndrome.
* Non-invasive diagnosis of coronary artery disease using Cardiogoniometry performed at rest, Schüpbach et al, Swiss Med Wkly. 2008; 138 (15–16): 230–238.
Cardiogoniometry (CGM) is a novel non-invasive method for the three-dimensional analysis of electrocardiographic data. The device used to perform CGM is the CARDIOLOGIC EXPLORER, which uses only 5 leads to create an orthogonal system that follows the anatomical axis of the heart. This allows a stress-free and automated assessment in only 12 seconds of measurement time.
The three-dimensional measurement and localization of cardiac potentials provides more than 300 parameters which allow for detection of myocardial ischemia amongst other conditions. In addition, the variability of vector loops as well as the maximum vectors of atrial and ventricular depolarization and ventricular repolarization is assessed. Through an understanding of electrocardiography it has been found that the signs for an existing myocardial ischemia do not emerge until the repolarization phase sets in and changes in depolarization are not detectable until after myocardial injury (infarction) has occurred. The same applies to CGM. Years of research and various studies have produced the following 10 conclusive statements:
|Statement on R (QRS complex)||Statement on T (STT complex)|
|1. The summation potential of R (=SumR) is an indicator of vital myocardial mass.||6. The summation potential of STT (=SumSTT) is an indicator of myocardial perfusion.|
|2. The maximum vector of R (=Rmax) indicates where the maximum of this mass is located.||7. The maximum vector of T (=Tmax) indicates where the blood supply is strongest.|
|3. Spread in Rmax or the R loop correlates to myocardial homogeneity.||8. Spread of Tmax or the T loop correlates to homogeneous perfusion.|
|4. Slight spread in Rmax is caused by breathing.||9. Slight spread in Tmax is caused by breathing.|
|5. Significant spread indicates a recent infarction.||10. Significant spread indicates acute ischemia.|
The CARDIOLOGIC EXPLORER Offers a Crucial Advantage:
More Safety. And it’s not Complicated.
The current recommendations for managing patients presumed to have ACS: “The initial step is to assign the patient without delay to a working diagnosis on which the treatment strategy will be based.“
The following diagnostic options are available:
- ECG provides the basic diagnostic information (STEMI).
- Recordings beyond the normal number of ECG leads are recommended, but rarely used in routine practice.
- CGM measures and analyses the electrical processes in the heart three-dimensionally:
- Supplies data exceeding data obtained by normal ECG.
- Evaluates depolarization and repolarization per heart beat and allows spatial analysis of beat-to-beat variability.
- Enables ischemia/diagnosis in the resting patient in just 12 seconds.
The clinical Trial “CGM@ACS” investigated a group of patients with chest pain and non-specific ECG:
- Multi-center at 8 German sites.
- Prospective, controlled.
- 200 patients with chest pain or acute dyspnoea.
- No STEMI.
- Cardiac catheterization within 72 hours.
The outcome of the CGM@ACS trial:
Cardiogoniometry represents a promising additional method that can be performed rapidly to supplement the findings based on 12 Lead Rest ECG and troponin levels in the early stage of diagnostics. Further studies on the detection of stable coronary heart disease and the significance of Cardiogoniometry in localizing ischemia are currently ongoing and/or in the planning stage.
The CGM@ACS Trial
The CGM@ACS trial investigated the novel method of Cardiogoniometry. The main target variables were efficacy and practicability. The results clearly demonstrated the numerous benefits of this new method and of its designated device, the CARDIOLOGIC EXPLORER.
|12 Lead Rest ECG.||Current gold standard in STEMI diagnosis.|
|Combines ECG & CGM methods.||More accurate diagnosis.
Enhanced safety in diagnosing ACS.
|Method validated by a variety of studies.||Reliable and accurate measurement.
Automatic interpretation of findings.
Unequivocal and conclusive extension of the ECG result.
Additional information immediately available as an adjunct to the
established biomarkers. Easier and faster decision-making.
|Non-invasive, stress-free, infinitely repeatable measurement.||Stress-free for the patient.
All types of patients can be examined.
Clinical follow-up possible.
|Graphic presentation of the finding.
Major plane follows the major anatomical axis of the heart.
|Easy to interpret.
Quick overview of patient’s status.
Simplified 3-D representation of electrical events.
|5 electrodes and 12-second measuring time.||Quick to apply.
Rapid results regardless of ischemia time (unlike biomarkers).
|Small, light-weight device.||Portable.
Can be moved easily between different rooms.