The 12-lead electrocardiogram (ECG) is the gold standard for the detection of myocardial ischemia. This is classically recorded with 10 electrodes attached to the patient’s torso and extremities. The EASI system, described by Dower in the 1980’s, is an alternative to this method. It uses vector electrocardiography and only 5 electrodes (4 recording + 1 grounding) to derive 12 leads1,2,3. The agreement between the EASI derived 12-lead ECG and the standard 12-lead ECG has been shown in many reviewed studies4-14.
CardioSecur’s technology is based upon the EASI standard. The agreement of the modified CardioSecur setting has been clinically proven and published15,16.
- There is >99% agreement between the CardioSecur ECG and a standard ECG for detection of myocardial ischemia and 100% agreement for its localisation16.
- EASI and standard 12-lead ECGs are comparable for cardiac diagnoses5, 9, 11.
- Derived ECGs are less susceptible to positional QRS changes than a standard ECG10.
- The EASI-derived 12-lead ECG is comparable to a standard 12-lead ECG for detecting ischemia6, 7, 12, 13.
- ST-segment depression detected by an EASI-derived ECG is comparable to that detected by a standard ECG, with a sensitivity and specificity for detecting myocardial ischemia at least equal to that of the standard ECG14.
- EASI is similar to a Mason-Likar ECG regarding susceptibility for baseline wander, and is less susceptible to myoelectric noise8.
For more detailed information and sources about the technology, see our Study Library.
A lead can be thought of as a viewpoint or angle of the heart. A standard ECG includes 12 leads, or 12 viewpoints of looking at the heart. However, the entire heart is not covered with these 12 leads. When a heart attack is suspected and the ECG is inconclusive, key guidelines from cardiac societies in Europe recommend recording additional leads17,18, particularly to look for the presence of a posterior myocardial infarction. A standard 12-lead ECG is not capable of including these key additional leads without the need to reattach the electrodes. CardioSecur Active includes 15 leads, adding 3 additional leads (V7-V9), and is thereby the only mobile ECG to implement this guideline into practice, leading to improved diagnosis and treatment.
- Using posterior leads in patients presenting with symptoms suspicious for heart attack reveals more patients with posterior myocardial infarction who benefit from early reperfusion treatment19.
- Posterior chest leads should be routinely recorded in patients with suspected myocardial infarction and non-diagnostic, routine electrocardiograms20.
- Isolated ST in leads V7 through V9 identifies patients with acute posterior wall myocardial infarction. Early identification of these patients is important for adequate triage and treatment of patients with ischemic chest pain without ST changes on a standard 12-lead ECG21.
- A 22-lead ECG has a higher sensitivity for diagnosis of acute myocardial infarction over a standard 12-lead ECG22.
More leads doesn’t mean more electrodes, time, or money. Find out how easy it is.
Time is muscle. The more time that passes between when an infarct occurs and when treatment is received, the higher the chances of heart muscle dying irreversibly. CardioSecur Active was developed to help users monitor their heart health on their own, helping them to receive treatment faster, and save heart muscle.
- Only 11% of myocardial infarction patients receive intervention within the first golden hour23, nearly 90% are too late.
- Energy reserves of the heart muscle typically only last for 20-60 minutes before necrosis of muscle tissue occurs23.
- Mortality increases by 7.5% for every 30 minutes that elapses before a patient with an ST-segment elevation is recognized and treated24.
- More than 90% of patients know that a heart attack can be deadly; however, 43% who suspected a heart attack still called for help too late (>1 hour later)25.
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Well-known risk factors such as smoking, an unhealthy diet, and an inactive lifestyle are not the only factors that increase your risk of heart disease—family history also plays a large role. When you know your risk, you can take the first step towards a healthy heart by initiating preventative measures.
- Premature parental history of a heart attack has been shown to increase the risk of a heart attack in men by about 50% and by approximately 70% in women26,27 .
- Approximately 13% of adults > 20 years old reported a 1st degree relative having a heart attack or angina before the age of 5028.
- Occurrence of a validated premature atherosclerotic cardiovascular event in a parent or a sibling was associated with a two-fold elevated risk for cardiovascular disease, independent of other traditional risk factors28.
Cardiovascular disease is responsible for more than half of all deaths across the European region29. The aim of CardioSecur Active is to help reduce this burden, allowing individuals with CVD to monitor their heart anytime and anywhere, helping them know how to react at all times via instant feedback. Coronary artery disease (CAD) is the leading cause of death worldwide30.
- Approximately 1 American will die every minute from a coronary event28.
- CAD is first detected when a heart attack occurs in 62% of men and 45% of women23.
- CAD is the single most frequent cause of death worldwide (12.8% of deaths, >7 million people yearly)30.
- The lifetime risk of developing coronary heart disease after 40 years of age is 49% for men and 32% for women26.
Learn if CardioSecur is the right fit for you.
Takeaway: >99% agreement between the two methods (CardioSecur ECG and standard 12-lead ECG); 0 false negatives with CardioSecur; 100% concordance with respect to localisation of myocardial ischemia.
Study Name: Comparison of Standard and Derived 12-lead Electrocardiograms Registrated by a Simplified 3-Lead Setting with Four Electrodes for Diagnosis of Coronary Angioplasty-induced Myocardial Ischemia16.
Authors: Klaus Bonaventura, Ernst Wellnhofer and Eckart Fleck.
Takeaway: Patients were given CardioSecur Active to record 15-lead ECGs weekly and when symptoms were present. 9.8% of patients were thereby diagnosed with new conditions (ischemic events, arrhythmias) allowing for successful treatment.
Study Name: The Revealing timely ECG changes Decreases the likelihood of Undesirable Cardiac Events-Trial (REDUCE-Trial)31.
Authors: Van Langenhove G, Schwagten B
Takeaway: The clinical information obtained from CardioSecur Pro is identical to that from the Philips M2601B monitor, allowing for the diagnostic capabilities of the devices to be seen as fully comparable.
Study Name: Comparative Study of the CardioSecur Pro ECG System with the EASI Philips M2601B15
Authors: David Triebl, Peter Kenedi, Istvan Preda, Adam Szekely, Marcus Skribek, Markus Riemenschneider
Takeaway: The body position in which the ECG is recorded (lying, sitting, or standing) does not have a significant impact on the ECG recording. A CardioSecur ECG can therefore be recorded in any of these positions without impacting the results.
Authors: P Kenedi, I Preda, J Thuer, A Szekely, M Skribek, D Triebl, A Abu Helous, M Riemenschneider
1Dower, GE. The ECGD: a derivation of the ECG from VCG leads. Journal of Electrocardiology, 1984. 17(2):189-91.
2Dower, GE, Machado HB and Osborne JA. On deriving the electrocardiogram from vectorcadiographic leads. Clinical Cardiology, 1980. 3(2):87-95.
3Dower, GE, Zakush A, Nazzal SB, et al. Deriving the 12-lead electrocardiogram from four (EASI) electrodes. Journal of Electrocardiology, 1988. 21 Suppl:182-7.
4Horacek, BM, Warren JW, Stovicek P and Feldman CL. Diagnostic accuracy of derived compared to standard 12-lead electrocardiograms. Journal of Electrocardiology, 2000. 33 Suppl:155-60.
5Drew, BJ, Pelter MM, Wung SF, et al. Accuracy of the EASI 12-lead electrocardiogram compared to the standard 12-lead electrocardiogram for diagnosing multiple cardiac abnormalities. Journal of Electrocardiology, 1999. 32:38-47.
6Drew, BJ, Adams MG, Pelter MM, Wung SF, and Caldwell MA. Comparison of standard and derived 12-lead electrocardiograms for diagnosis of coronary angioplasty-induced myocardial ischemia. American Journal of Cardiology, 1997. 79(5):639-44.
7Rautaharju, PM, Zhous SH, Hancock EW, et al. Comparability of 12-lead ECGs derived from EASI leads with standard 12-lead ECGs in the classification of acute myocardial ischemia and old myocardial infarction. Journal of Electrocardiology, 2002. 35 Suppl:35-9.
8Welinder A, Sörnmo L, Field DQ, et al. Comparison of signal quality between EASI and Mason-Likar 12-lead electrocardiograms during physical activity. American Journal of Critical Care, 2004. 13(3):228-234.
9Drew BJ, Scheinman MM, and Evans GT, Jr. Comparison of a vectorcardiographically derived 12-lead electrocardiogram with the conventional electrocardiogram during wide QRS complex tachycardia, and its potential application for continuous bedside monitoring. American Journal of Cardiology, 1992. 69(6):612-8.
10Adams, MG. and Drew BJ. Body position effects on the ECG: implication for ischemia monitoring. Journal of Electrocardiology, 1997. 30(4):285-91.
11Drew, BJ, Pelter MM, Brodnick DE, et al. Comparison of a new reduced lead set ECG with the standard ECG for diagnosing cardiac arrhythmias and myocardial ischemia. Journal of Electrocardiology, 2002. 35 Suppl:13-21.
12Wehr G, Peters RJ, Khalife K, et al. A vector-based, 5-electrode, 12-lead monitoring ECG (EASI) is equivalent to conventional 12-lead ECG for diagnosis of acute coronary syndromes. J Electrocardiology, 2006 Jan;39(1):22-8.
13Sejersten M, Wagner GS, Pahlm O, et al. Detection of acute ischemia from the EASI-derived 12-lead electrocardiogram and from the 12-lead electrocardiogram acquired in clinical practice. J Electrocardiology, 2007 Apr;40(2):120-6.
14Feldman CL, MacCallum G, and Hartley LH. Comparison of the standard ECG with the EASIcardiogram for ischemia detection during exercise monitoring. Computers in Cardiology, 1997. Lund pp. 343-345.
15Triebl D, Kenedi P, Preda I, et al. Comparative study of the CardioSecur pro ECG system with the EASI Philips M2601B. Personal MedSystems Frankfurt, Central Hospital of the Hungarian Defence Forces Budapest. Abstract presented eCardiology Congress 2016: Berlin.
16Bonaventura K, Wellnhofer E, and Fleck E. Comparison of standard and derived 12-lead electrocardiograms registrated by a simplified 3-lead setting with four electrodes for diagnosis of coronary angioplasty-induced myocardial ischemia. European Cardiology, 2012 Jul; 8(3): 179.
17Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC), European Heart Journal, Volume 39, Issue 2, 7 January 2018, Pages 119-177, doi.org/10.1093/eurheartj/ehx393.
18Roffi M, Patrono C, Collet J, et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC), European Heart Journal, Volume 37, Issue 3, 14 January 2016, Pages 267–315, doi.org/10.1093/eurheartj/ehv320.
19Van Gorselen EOF, Verheugt FWA, Meursing BTJ, and Ophuis AJM. Posterior Myocardial Infarction: the dark side of the moon. Neth Heart Journal, 2007 Jan;15(1):16-21.
20Agarwal JB, Khaw K, Aurignac F, and LoCurto A. Importance of posterior chest leads in patients with suspected myocardial infarction, but nondiagnostic, routine 12-lead electrocardiogram. American Journal of Cardiology, 1999 Feb;83(3):323-6.
21Matezky S, Freinmark D, Feinberg MS, et al. Acute myocardial infarction with isolated ST-segment elevation in posterior chest leads V7-9: „hidden“ ST-segment elevations revealing acute posterior infarction. Journal of the American College of Cardiology, 1999 Sep;34(3):748-53.
22Justis DL and Hession WT. Accuracy of 22-lead ECG Analysis for diagnosis of acute myocardial infarction and coronary artery disease in the emergency department: a comparison with 12-lead ECG. Annals of Emergency Medicine, 1992 Jan;21(1):1-9.
23Schneider H, Weber F, and Nienaber C. Die Therapie des Herzinfarkts. Published in Herzinfarkt: Unvermeidbares Schicksal? Nov 2005. Deutsche Herzstiftung e.V.
24De Luca G, Suryapranata H, Ottervanger JP, and Antman EM. Time delay to treatment and mortality in primary angioplasty for acute myocardial infarction: every minute of delay counts. Circulation, 2004 Mar 16;109(10):1223-5.
25Becker HJ. Herzinfarkt: ein Wettlauf mit der Zeit. Published in Herzinfarkt: Unvermeidbares Schicksal? Nov 2005. Deutsche Herzstiftung e.V.
26Lloyd-Jones DM, Nam BH, D’Agonistino RB, et al. Parental Cardiovascular disease as a risk factor for cardiovascular disease in middle-aged adults: a prospective study of parents and offspring. JAMA, 2004. 291:2204-2211.
27Sesso HD, Lee I, Gaziano JM, et al. Maternal and paternal history of myocardial infarction and risk of cardiovascular disease in men and women. Circulation, 2001. 104:393-398.
28Veronique LR, Go AS, Lloyd-Jones DM, et al. Heart Disease and Stroke Statistics- 2011 Update. A Report from the American Heart Association. Circulation, 2011 Feb 1;123(4): 318-e209. Accessed from http://circ.ahajournals.org/content/123/4/e18.long.
29WHO Data and Statistics, accessed 12.01.2018 from: http://www.euro.who.int/en/health-topics/noncommunicable-diseases/cardiovascular-diseases/data-and-statistics.
30WHO Fact Sheet, updated June 2011. http://www.who.int/mediacentre/factsheets/fs310/en/index.html.
31Van Langehove G and Schwagten B. The Revealing timely ECG changes Decreases the likelihood of Undesirable Cardiac Events-Trial (REDUCE-Trial). Poster presented at ESC Congress 2014: Barcelona.