Frequently Asked Questions - Example A-ECG Reports

FAQs - Example A-ECG Reports

Ima Starr is a 61-year old woman who was undergoing a thorough executive health examination that included a normal resting 5-min conventional 12-lead ECG. She is completely asymptomatic and very health conscious. As part of her executive health exam, she ultimately had normal results on several cardiac imaging tests too. Her A-ECG Report, produced from the digitally stored data comprising her 5-min ECG, was also completely normal, consistent with her normal cardiac imaging results. In her case, A-ECG Heart Age Scoring (see page 5 of her A-ECG Report) also suggested that her Heart Age by A-ECG was more than 3 years younger than her true chronological age. Ms. Starr and her clinician were thus very encouraged by this result.

Will B. Young is an asymptomatic 47-year old man with hypertension. He has no known coronary artery disease or other heart disease, and his prior imaging results and recent resting 5-min conventional 12-lead ECG were all considered clinically unremarkable. His A-ECG Report, produced from the digitally stored data comprising his 5-min ECG, was also negative for cardiac diseases, consistent with his imaging results and clinical history. However, results from A-ECG Heart Age Scoring (see page 5 of his A-ECG Report) suggested that his Heart Age by A-ECG was higher than his true chronological age, probably due at least in part to his underlying hypertension. Thus Will would likely benefit from improvements to his lifestyle and/or from other measures suggested by his clinician to help him better control his high blood pressure and other cardiovascular risk factors. If Will is successful in implementing lifestyle and other improvements, it's quite possible that his A-ECG Age Score will improve on follow-up 5-min ECGs.  

Aida Maines is a 69-year old woman who complained of vague chest discomfort, especially with exertion. Nonetheless she recently had a normal resting 5-min conventional 12-lead ECG. However, her A-ECG Report, produced from the digitally stored data comprising her 5-min ECG, was clearly abnormal (positive for "Disease", per the report's page 3). Moreover the discriminant analysis (or "SpaceEKG") component of her A-ECG Report (see its page 4) suggested that her specific type of underlying heart disease was most likely coronary artery disease.  Her derived vectorcardiogram (VCG, see the last page of her A-ECG and conventional ECG reports) also suggested that she might have already had a small heart attack in the past, in spite of her normal conventional 12-lead ECG. In her case, because her main A-ECG scores were positive for "Disease"A-ECG Heart Age Scoring was not performed, because such scoring is only relevant to those individuals whose main A-ECG scores are "negative" for Disease (i.e., whose results most resemble those of known "Healthy" patients in the underlying A-ECG database). Aida Maines also had an exercise stress test, which showed notable ST segment depression before peak exertion. As a result, she went on to have a coronary angiogram, which revealed severe left main coronary artery disease and also an ostial lesion of the left circumflex coronary artery -- i.e., so-called "critical anatomy". She was treated appropriately for her severe coronary artery disease. Her left ventricular ejection fraction was normal, a finding consistent with her negative A-ECG score for left ventricular systolic dysfunction (LVSD), which is one of the additional sub-scores shown on page 3 of her A-ECG Report

Tavis Reddy is a 74-year old man who underwent evaluation for shortness of breath and a heart murmur. His standard, resting (10-sec) conventional 12-lead ECG was clinically unremarkable. Nonetheless, his A-ECG Report, produced from the digitally stored data comprising his 12-lead ECG, was clearly abnormal (positive for "Disease"), and moreover the discriminant analysis ("SpaceEKG") component of his A-ECG Report (see its page 4) suggested that his specific type of underlying heart disease was most likely left ventricular hypertrophy or enlargement (aka "left ventricular electrical remodeling", when diagnosed by means of ECG or in this case by A-ECG). An echocardiogram revealed severe aortic valvular stenosis and left ventricular hypertrophy, with notably increased left ventricular mass. Mr. Reddy ultimately underwent a Transcatheter Aortic Valve Implantation (TAVI) procedure to relieve his aortic stenosis and symptoms. His A-ECG score for LSVD was negative (see page 3 of his A-ECG Report), consistent with his normal left ventricular ejection fraction by echocardiography. There was also no evidence of hypertrophic cardiomyopathy by either A-ECG or echocardiography. 

M.T. Chambers is an asymptomatic 39-year old man with "non-specific ST-T wave changes" on his standard, resting (10-sec) conventional 12-lead ECG, a common and often benign clinical finding. Because he had a family history of heart problems, Mr. Chambers went on to have an extensive cardiac workup, including imaging tests and, based on results from those, eventually genetics tests too. An A-ECG Report produced for Mr. Chambers from the digitally stored data comprising his same (i.e., "borderline") 12-lead ECG suggested a high probability for "Disease", and specifically a high probability for hypertrophic cardiomyopathy (see the discriminant analysis or "SpaceEKG" component of his A-ECG Report on its page 4). Mr. Chambers' clinical imaging results and blood testing eventually pinpointed the presence of a genetic hypertrophic cardiomyopathy. It's nonetheless of note that a specific diagnosis by A-ECG of hypertrophic cardiomyopathy in Mr. Chambers' case required nothing more than access to his digitally stored 12-lead ECG data file.

Kent C. Long is a 14-year old male who had a syncopal episode, prompting a medical workup that included a standard, resting (10-sec) conventional 12-lead ECG. His conventional ECG was read as clinically normal, and Kent was otherwise in good health. However, in spite of his normal conventional ECG and its associated normal QTc (corrected QT) interval, an A-ECG Report produced for Kent from the digitally stored data comprising his "read as normal" conventional 12-lead ECG suggested a high probability of "Disease".  More specifically, the discriminant analysis ("SpaceEKG") component of his A-ECG Report (see its page 4) suggested a high probability of a long QT syndrome (LQTS). An extensive work-up that included genetics testing at a tertiary academic institution revealed that Kent did indeed have a genetic long QT syndrome, the likely reason for his syncope.

Linked below are example A-ECG Reports and accompanying conventional 12-lead ECGs for the above individual patients.  An important point is that all of these patients had normal or clinically unremarkable conventional 12-lead ECGs. However, they all had very different A-ECG results, as can be seen from their respective A-ECG Reports, and from their respective clinical stories as noted in the preceding section.

Ima Starr (A-ECG Report from full-disclosure 12-lead ECG)  (Accompanying conventional 12-lead ECG and derived VCG)  

Will B. Young  (A-ECG Report from full-disclosure 12-lead ECG)  (Accompanying conventional 12-lead ECG and derived VCG

Aida Maines (A-ECG Report from full-disclosure 12-lead ECG)  (Accompanying conventional 12-lead ECG and derived VCG

Tavis Reddy (A-ECG Report from 10-sec snapshot 12-lead ECG)  (Accompanying conventional 12-lead ECG)  

M.T. Chambers (A-ECG Report from 10-sec snapshot 12-lead ECG)  (Accompanying conventional 12-lead ECG)  

Kent C. Long (A-ECG Report from 10-sec snapshot 12-lead ECG)  (Accompanying conventional 12-lead ECG

All seven members of the GlobeRunners professional athletics team whose A-ECG results are included in the example A-ECG Group Report below were asymptomatic, their 12-lead ECGs having been performed for screening and other purposes. Three of the team's endurance-trained athletes had "borderline abnormal" conventional 12-lead ECGs. Specifically, Athlete 1's conventional 12-lead ECG showed a prolonged corrected QT (QTc) interval (=452 ms; "normal" QTc values for adult males being <440 ms) and also a minor intraventricular conduction delay (QRS interval =110 ms). Athlete 3's conventional 12-lead ECG showed very high QRS voltages that met Sokolow-Lyon criteria for the presence of left ventricular hypertrophy, i.e., S wave voltage in lead V1 plus R wave voltage in lead V5 or lead V6 (whichever is greater) >3.5 mV. Finally, Athlete 7's conventional 12-lead ECG showed ST segment elevation in several leads. However, in spite of their "borderline" conventional 12-lead ECGs, all three of these athletes (and also all four of the other athletes who had more "normal" appearing conventional 12-lead ECGs) had completely normal or "Healthy" results by A-ECG, as shown within their A-ECG Group Report. As also shown within their A-ECG Group Reportof the five athletes who had 5-min 12-lead ECGs suitable for A-ECG Heart Age Scoring, one (Athlete 1) had an A-ECG Age Score higher than his true chronological (or "body") age, two had A-ECG Age Scores lower than their true chronological ages, and two had A-ECG Age Scores statistically no different than their true chronological ages. Finally, all seven of these athletes also had normal results by echocardiography, thus further validating, by cardiac imaging, the main A-ECG results.  

Within A-ECG Group Reports, A-ECG results for more than one person are presented within a single, simpler, A-ECG Report that contains slightly less detailed information for each individual patient. In the case of the GlobeRunners, the example A-ECG Group Report contains A-ECG results for seven healthy members of a professional athletics team, three of whom had borderline abnormal conventional 12-lead ECGs, as noted above. Thus whereas the example A-ECG Reports for several of the individual patients in the prior section demonstrate A-ECG's relatively increased sensitivity, compared to strictly conventional 12-lead ECG, the A-ECG Group Report for the GlobeRunner athletes below demonstrates A-ECG's relatively increased specificity. 

The GlobeRunners (Professional Athletics Team)  (A-ECG Group Report)  (Accompanying conventional 12-lead ECG and derived VCG for Athlete#1) (Accompanying conventional 12-lead ECG and derived VCG for Athlete #3) (Accompanying conventional 12-lead ECG and derived VCG for Athlete #7)

It is also possible to utilize A-ECG as a way to serially monitor the status of heart failure, including for example the potential success vs. failure of treatments instituted for a patient's heart failure in an outpatient or inpatient (hospital) setting. Linked herein is an example Serial A-ECG Results Report for a 43 year-old male who presented to a hospital with accelerated hypertension and a non-specifically abnormal conventional 12-lead ECG showing sinus tachycardia and ventricular ectopy (the patient's admission conventional 12-lead ECG is linked here, and also below as serial conventional ECG #1). At the time of his admission 12-lead ECG, the patient's blood NT-BNP biomarker was also elevated (333 pmol/l, reference normal value <35), suggesting possible heart failure. An echocardiogram showed left ventricular hypertrophy with severely dilated LV and LV systolic dysfunction. Cardiac MRI also later confirmed the presence of non-ischemic cardiomyopathy (NICM), whereas a coronary angiogram showed only minimal coronary artery disease.  Over a 10-day period the patient received appropriate medical therapy in the hospital for his diagnosis of severe hypertensive NICM, and he was ultimately discharged on appropriate medications in greatly improved condition.

A-ECGs were obtained sequentially from the patient during his 10-day hospitalization period, specifically by utilizing the stored data files from his five in-hospital serial conventional (10-sec snapshot) 12-lead ECGs. As shown in his Serial A-ECG Results Report, the patient's A-ECG result at hospital admission (result labeled #1 on page 3 and elsewhere in the Report) correctly diagnosed his LVSD, while at the same time his SpaceEKG result at admission (see pages 3-4 of the same Report) pinpointed NICM as the most likely cause for his LVSD. His serial A-ECG and SpaceEKG results (labeled as 2 through 5 in the Report, corresponding temporally to serial conventional 12-lead ECGs #2, 3, 4 and 5) then showed progressive improvement over time, commensurate with his improving condition as successful medical treatment progressed.

Patient undergoing treatment for new-onset heart failure: (Serial A-ECG Results Report) (Accompanying serial conventional 12-lead ECGs:  #1, #2, #3, #4 and #5