Circulation, Vol 71, 523-534, Copyright © 1985 by American Heart Association
JL Willems, P Arnaud, JH van Bemmel, PJ Bourdillon, C Brohet, S Dalla Volta, JD Andersen, R Degani, B Denis and M Demeester
To allow an exchange of measurements and criteria between different
electrocardiographic (ECG) computer programs, an international cooperative
project has been initiated aimed at standardization of computer-derived ECG
measurements. To this end an ECG reference library of 250 ECGs with
selected abnormalities was established and a comprehensive reviewing scheme
was devised for the visual determination of the onsets and offsets of P,
QRS, and T waves. This task was performed by a group of cardiologists on
highly amplified, selected complexes from the library of ECGs. With use of
a modified Delphi approach, individual outlying point estimates were
eliminated in four successive rounds. In this way final referee estimates
were obtained that proved to be highly reproducible and precise. This
reference data base was used to study measurement results obtained with
nine vectorcardiographic and 10 standard 12-lead ECG analysis programs. The
medians of program determinations of P, QRS, and T wave onsets and offsets
were close to the final referee estimates. However, an important
variability could be demonstrated between measurements from individual
programs and mean differences from the referee estimates amounted to 10
msec for QRS for certain programs. In addition, the variances of all
programs with respect to the referee point estimates were variable. Some
programs proved to be more accurate and stable when the data from high- vs
low-noise recordings were analyzed. Average Q wave durations calculated
from ECGs for which programs agreed on the presence of a Q or QS wave
differed by more than 8 msec in several program-to-program comparisons.
Such differences may have important consequences with respect to diagnostic
performance. Various factors that might explain these differences have been
determined. The present study demonstrates that to allow an exchange of
results and diagnostic criteria between different ECG computer programs,
definitions, minimum wave requirements, and measurement procedures urgently
need to be standardized.
ARTICLES
Assessment of the performance of electrocardiographic computer programs with the use of a reference data base
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