Minimal lead sets for reconstruction of 12-lead electrocardiograms

It may not always be possible to record all precordial leads of the standar d 12-lead electrocardiogram (ECG). Especially in monitoring situations, a m inimal lead set from which the 12-lead ECG can be reconstructed, would be v aluable. This article assesses how well missing precordial leads could be s ynthesized from the remaining leads of the 12-lead EGG. A total of 2,372 di agnostic 12-lead ECG recordings were obtained from subjects with chest pain suggestive fur acute myocardial infarction. Representative average beats w ere computed from the digital 12-lead ECG recordings with our Modular ECG A nalysis System. The recordings were divided into a learning set and a test set. We considered all lead sets with one or more precordial leads removed, but always including limb leads I and II. By using the learning set, gener al reconstruction coefficients were computed to synthesize the missing: pre cordial leads to each lead set. Performance of the synthesis was assessed b y cross correlation between the original and the reconstructed leads. Also, patient-specific reconstruction coefficients were derived for each ECG in the test set and correlations were determined. High correlation coefficient s were found with both reconstruction techniques. For different sizes of le ad sets, the best patient-specific reconstructions had higher correlation v alues than the general reconstructions. For example, when 2 precordial lead s were excluded, the best patient-specific median correlation was 0.994 com pared to 0.963 for the best general reconstruction correlation. General rec onstruction allows synthesis of 2 or 3 excluded precordial leads in good ap proximation. When patient-specific reconstruction can be applied, a minimal lead set including the limb leads and only 2 precordial leads suffices.