Marquette ™ 12SL Algorithm Connected Clinical Excellence
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Marquette™ 12SL Algorithm
Connected Clinical Excellence
Clinical decision support for your ECGSince its introduction in 1980 the MarquetteTM 12SL ECG analysis program has been consistently refined and improved in order to offer our customers the best possible clinically validated decision support to achieve faster accurate diagnosis.
• Exceedscurrentstandards1 for 12- and 15-lead measurements and analysis
• Providesaccurate,validatedmeasurementsofheartrate,axis, intervals,anddurations
• Offersautomatedsecondopinionminimizingtimespent over-reading ECGs
• OffersECGanalysisincludingthoseforatrialarrhythmias,pace detection,andQTmeasurement
• OffersquickqualitycheckofECGs(Hook-upadvisor)
• Offersgenderandage-drivencriteriaforacuteMI;utilizedin pre-hospital defibrillators to identify clinically significant changes andexpeditepatientcareintime-criticalenvironments
• Dedicatedpaediatriccriteria
• SupportingdecisionsonECGacrossthecarecontinuum
19861980 1991 2000 2004 2006 2011
Serial Comparison
PaediatricAnalysis
Gender-specificcriteria
Hookup Advisor
Right Ventricular Involvement
PaceStatementsAcute Coronary
Syndrome
2003
QT Algorithm
Serial Comparison Paediatric Analysis
TheMarquetteSerialComparisonProgramindicateschanges in the ECG from the previous ECG of the samepatient.Itutilizesinterpretivestatements, ECG measurements and waveform comparison techniquestomaximizeaccuracyinthedetection of clinically significant changes. Serial comparison requires the MUSE ECG management system.
Benefit: • Consistentvalidated1 analysis and comparison ensures reproducibility and objectivity for increased efficiency in the process.
Children are not the same as adults and neitheraretheirECGs.Increasedrightventricularsize,increasedheartrateandnarrowercomplexeswouldleadtodifferent interpretation in an adult ECG. Totakethisintoaccount,ifanageoflessthan 16 years is entered the Marquette 12SL program employs paediatric criteria. Inadditionthepossibilitytoapply15leads allows different positions to cater for the differences in paediatric anatomy.
Benefit: • Accuratepaediatricspecificmeasure- ment and interpretation validated by independent study with over 1.100 paediatric ECGs.1
12 Age groups applied to ECG analysis
Less than one day old
At least a day old but not more than 2 days
3 to 6 days old
1to3weeksold
1 to 2 months old
3 to 5 months old
6 to 11 months old
1 to 2 years old
3 to 4 years old
5 to 7 years old
8 to 11 years old
12 to 15 years old
19861980 1991
Serial Comparison
PaediatricAnalysis
Gender-specific criteria
Justlikechildren,adultmenandwomenarealsodifferentandthisdifferenceextendstotheECG.Marquette 12SL with Gender- Specific interpretation applies criteria for evaluating the ST segment and T-waveoftheECGwaveform,improvingsensitivitytoacute myocardial infarction in women and enhancing diagnostic confidence.
Benefit: • Improvesthesensitivityfordetectionofacuteanterior MIfrom42%to48%inwomenunder60yearsofage.2
• 25%relativeimprovementindetectionofacute inferiorMIinwomenunder60yearsofagewithout sacrificing the high specificity already maintained by the program.3
2000
Gender-specificcriteria
2003
QT Algorithm
QT Algorithm
ItiswellrecognizedthattheidentificationofprolongedQTisimportant as the condition can result in serious arrhythmia and SuddenCardiacDeath.4However,itcanbedifficulttomeasureQTaccuratelyduetofactorssuchasECGnoise,difficultydefiningtheendoftheTwave,andrequiringcorrectionsforheartrate.GEhasconcentrateditseffortsinhelpingtominimizethesechallengesthroughtheMarquette12SLprogram.TheQTismeasuredfromamediancomplexreducingtheinfluenceofnoise,itisalsomeasuredfrom global fiducial points from all 12 simultaneous leads.
Benefit: • Consistent,reproducableandaccuratemeasurementand interpretation
• OffersmultipleQTcorrectionfactorsincludingBazett, Framingham,andFridericiaSTEMI/ACS
Byusingallleadsofthemediancomplextodefinetheendofventricularrepolarization, Marquette12SLoffersaccuracyandconsistencyinQTmeasurement
Right Ventricular Involvement (RVI)
RightVentricularInvolvement(RVI)isassociatedwithasignificantlygreaterriskofin-hospitalmortalityandmajor in-hospital complications.5FollowingtheAHA/ACCstandards6 Marquette 12SL will call out from the regular 12-lead ECG that RV involvement should be considered.
Benefit: • Reducedriskofdeathshockandarrythmiasthrough improved diagnosis on the 15-lead ECG on the basis of an ST-segment elevation in the right precordial leads(e.g.leadV4R)7
• Marquette12SLisguidingtheuseronwhento considerRVIandapply15-leads
• Validatedonamulti-sitedatabaseofover1.300 chest pain ECGs.
Becausetreatmentofinfarctionmay vary with right ventricular involvement,recordingofadditionalright-sided precordial leads during acuteinferiorwall,leftventricularinfarction is recommended. Routi-nerecordingoftheseleads,intheabsenceofacuteinferiorinfarction,is not recommended. (Circulation2007).8
Superior Vena Cava
Acute Marginal
Artery
Right Coronary
Artery
Left Anterior Descending Artery
Left Main Coronary Artery
Aorta
Pulmonary Trunk
Right Coronary Thrombus
2004 2006
Hookup Advisor
Right Ventricular Involvement
Hookup Advisor
MarquetteHookupAdvisorenableshighquality ECGs by measuring impedance plus the signal quality of the ECG leads.
• Theeasytounderstandred-yellow-greensignal indicates the quality of the ECG. • TheHookupadvisornotonlytakesskincontact throughimpedanceintoconsideration,butalso looksattheECGsignalandelectrodemotion ornoisecomingfrommovement,ACor muscle tremor.
Benefit: • Thesystemindicatesthecauseofinterference, so that the root cause can be eliminated without using higher filters.
Pace Statements
Bipolarpacinghasleadtoareductionofpulseamplitudes and width.9 Therefore it is necessary to detectpacemakerpulsesatasamplingratethatismuchgreaterthanisrequiredforconventionalECGanalysis.InconjunctionwiththeCAMHD,GE’shigh-definitionECGacquisitionmodule,theMarquette12SLprogramisableto identify a biventricular paced rhythm.
• Thepacemakerannotationchannelwillthenbe shown in the MUSETM ECG management system
• Validationofpacemakerdetectioninthree different studies1
Benefit: • Marquette12SLprovidesanalysisfordetecting bi-ventricularpacemakers,identifyingtheunderlying rhythm,inadditiontothechamber(s)beingpaced
Acute Coronary Syndrome (ACS) Tool
The Marquette 12SL ACS tool* increases sensitivity for ST-ElevatedMIorAcuteIschemiainpatientssuspectedof having an acute cardiac event. The tool heavily weighs the finding of ST elevation with reciprocal ST depression. This is a very important and highly-specific indicator of STEMIandACSthathasbeenfoundto“identifypatientswho stand to benefit most from early interventional strategies.”10 Astudyevaluatedonover1,900clinicallycorrelatedECGs1 from patients suspected of having ACS showed that the ACS tool:
Benefit: • Improvedthesensitivityofemergencyphysicians’ interpretation of acute myocardial infarction by 50%andcardiologists’interpretationsby26%, with no loss of specificity11
• Improvedthesensitivityofemergency physicians’acuteischemicsyndrome interpretationby53%while maintaining a specificity of91%11
2011
PaceStatementsAcute Coronary
Syndrome
Recommendations of filtering• ToavoiddistortionoftheSTsegmentthelow-frequencycut-offshouldbe nohigherthan0.67Hzin“auto”mode,or0.05Hzin“manual”mode.8 • Topreventthelossofhighfrequencyinformationthehighfrequency cutoffshouldbenolowerthan150Hzinadultsandadolescents.8
Benefit: • HookupAdvisorwilllistthecauseofinterferenceisindicatedtoremove root-cause potentially avoiding the need of filtering
• Flexiblefiltersettingsallowpermanentandad-hockchangestofilter if needed
ECG Recording - why quality matters...The outcome of the ECG measurement and interpretation improve with the quality of the ECG recording and processing. ThereforetheAHA/ACCestablishedECGstandardsandrecommendationstoimprovetheaccuracyandusefulnessoftheECGinpractice.12
Recommendations on electrode positioning• ElectrodesmustbepositionedinaccordancewithAHArecommendations. Ifanyoftheelectrodeneedtobesitedinnon-standardpositionsthe recording must be labelled with this information to avoid misinterpretation of altered ECG waveforms.12,13,14
Benefit: • Hook-upadvisorindicatesthequalityoftheECGwith an easy-to-understand red-yellow-green signal
• Suspectarmleadreversalsareindicated,butnot considered in the interpretation
• Toolsandtrainingmaterialssupportcorrectpositioning
More than
300,000,000ECGs are recorded in Europe every year.15
TheECGisaquick,non-invasiveprocedure that many patients undergo as the first test!
Clinically validated ECG measurement and interpretationThe IEC Standard 60601-2-25:201116 defines the validation requirements:
Measurement accuracy
• Rhythminterpretationaccuracymustbetestedonatleast1.500ECGs, 100 with Afib
Diagnosticinterpretationaccuracy • Accuracymustbevalidatedvianon-ECGdata • Performanceinformationshallbedisclosedinaccompanyingdocuments andreadilyavailabletocustomerswhowanttoknowtheinformation
The Marquette 12SL ECG analysis program is continually refined through the following processes1:
• Regularclinicalinput–continuousinputisgatheredfromsomeofthe world’stopconsultingcardiologistsandphysicians.
• Clinicallycorrelateddatabases–GEutilizesdifferentdatabasesduring the development and validation processes to enhance program accuracy.
• Beyondclinically-correlateddatabasesGEmeasuresitsanalysis programperformanceonalargedatabaseofECGs(>50,000). This process challenges the program with multiple diseases and varying degrees of abnormality. ECGs with changed analysis results due to program modification can be further investigated with expertconfirmation.
Benefit:
• Improvedprogramaccuracy,whichhelpsclinicianstoimprovepatientcare.
Marquette 12SL
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Disclosure of Accuracy/ Confirmation1
ICE60601-2-51inproductspecification-performance standard for ECG analysis
Measurement Accuracy via CSE database
Stabiliy of measurements in presence of noise - CSE recordings
Rhythm interpretation accuracy on over 1.500 ECGs by cardio-logist,includesatleast100ECGswithartrialfibrillation
Accuracy of conduction abnormalities by cardiologist
AccuracyofLVH,RVH,oldinfarctionviaCSEdatabase(NEJM1991)
STEMIconfirmedbycardiacenzymes&clinicaloutcome
Acute ischemia via longitudinal clinical outcome
AccuracyofQTmeasurementbycorelabanddrugdosage
Independentevaluation:articleswhereinventor/vendor is not an author
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>30
Connected Clinical Excellence
MAC 600 Electrocardiograph
MAC 800 Electrocardiograph
MAC 2000 Electrocardiograph
CardioSoftDiagnosticSystem
MAC 3500 Electrocardiograph
MAC5500HD Electrocardiograph
CARESCAPEMonitor
SEER 12 Holterrecorder
www.gehealthcare.com
GEHealthcareprovidestransformationalmedicaltechnologiesand services that are shaping a new age of patient care.
Ourbroadexpertiseinmedicalimagingandinformationtechnologies,medicaldiagnostics,patientmonitoringsystems,drugdiscovery,biopharmaceuticalmanufacturingtechnologies,performanceimprovementandperformancesolutions services help our customers to deliver better care to more people around the world at a lower cost.
Inaddition,wepartnerwithhealthcareleaders,strivingtoleverage the global policy change necessary to implementa successful shift to sustainable healthcare systems.
Imagination at work
GEHealthcare P.O.Box900, FIN-00031GE,Finland GEDirectUnitedKingdom:+44(0)8000329201
©2016GeneralElectricCompany–Allrightsreserved.
GeneralElectricCompanyreservestherighttomakechangesinspecificationsandfeaturesshownherein, or discontinue the product described at any time without notice or obligation.
GE,GEMonogram,Imaginationatwork,Marquette,MUSE,MAC,CardioSoftandCARESCAPEaretrademarks of General Electric Company.
GEHealthcare,adivisionofGeneralElectricCompany.
JB39052XE04/2016
References:
1 Marquette™12SL™ECGAnalysisProgramPhysician’sGuide2036070-006RevisionC,2010, 2012 General Electric Company
2 Wright,R.S.,et.al.“WomenwithAcuteAnteriorMyocardialInfarctionHaveLessPrecordial STElevationThanMenIndependentofAgeofPresentation.”JAmCollCardiol.37(2001):361A.
3 Xue,J.,et.al.“ANewMethodtoIncorporateAgeandGenderIntotheCriteriafortheDetection ofAcuteInferiorMyocardialInfarction.”JElectrocardiol.34(4)(Part2)(Oct2001):229-234.
4 Al-KhatibSM,et.al.,WhatCliniciansShouldKnowAbouttheQTIntervall,Jama2003; 289(16):2120-2127.
5 Zehender,M.,etal.(1993).“Rightventricularinfarctionasanindependentpredictorof prognosisafteracuteinferiormyocardialinfarction.”NEnglJMed
6 AntmanEM,AnbeDT,ArmstrongPW,BatesER,GreenLA,HandM,etal.ACC/AHAguidelines for the management of patients with ST-elevation myocardial infarction: a report of the AmericanCollegeofCardiology/AmericanHeartAssociationTaskForceonPractice Guidelines(CommitteetoRevisethe1999GuidelinesfortheManagementofPatientswith AcuteMyocardialInfarction).Circulation.2004;Aug31;110(9):e82-292.
7 “PatientswithinferiorMIwhoalsohaveRVmyocardialinvolvementareatincreasedrisk ofdeath,shockandarrhythmias.”Mehta,S.R.,etal.(2001). “Impactofrightventricularinvolvementonmortalityandmorbidityinpatientswithinferior myocardial infarction.” J Am Coll Cardiol
8 KligfieldP,GettesLS,BaileyJJ,ChildersR,DealBJ,HancockEW,etal.Recommendations fortheStandardizationandInterpretationoftheElectrocardiogram.PartI:The ElectrocardiogramandItsTechnology.AScientificStatementFromtheAmericanHeart AssociationElectrocardiographyandArrhythmiasCommittee,CouncilonClinicalCardiology; theAmericanCollegeofCardiologyFoundation;andtheHeartRhythmSociety.Endorsedby theInternationalSocietyforComputerizedElectrocardiology.Circulation.2007Feb23.
9 Improvedpacemakerplusedetection:clinicalevaluationofanewhigh-bandwith electrocardiographicsystem.JElectrocardiol,2011.
10 Otto,L.A.andT.P.Aufderheide,EvaluationofSTsegmentelevationcriteriafortheprehospital electrocardiographic diagnosis fo acute myocardial infarction. AnnEmergMed,1994.23(1):p.17-24.
11 Xue,J.,etal.,Addedvalueofnewacutecoronarysyndromecomputeralgorithmfor interpretationofprehospitalelectrocardiograms.JElectrocardiol,2004.37Suppl:p.233-9.
12 RecommendationsfortheStandardizationandInterpretationoftheElectrocardiogram,Paul Kligfield,MD,FAHA,FACC;LeonardS.Gettes,MD,FAHA,FACC;JamesJ.Bailey,MD;Rory Childers,MD;BarbaraJ.Deal,MD,FACC;E.WilliamHancock,MD,FACC;GerardvanHerpen, MD,PhD;JanA.Kors,PhD;PeterMacfarlane,DSc;DavidM.Mirvis,MD,FAHA;OllePahlm,MD, PhD;PenttiRautaharju,MD,PhD;GalenS.Wagner,MD,2007bytheAmericanHeartAssocia- tion,Inc.,theAmericanCollegeofCardiologyFoundation,andtheHeartRhythmSociety
13 KossmanCE,BrodyDA,BurchGE,HechtH,JohnstonFD,KayC,LepeschkinE,PipbergerHV, BauleG,BersonAS,BrillerSA,GeselowitzDB,HoranLG,SchmittOH.Recommendationsfor standardizationofleadsandofspecificationsforinstrumentsinelectrocardiographyand vectorcardiography.Circulation1967;35:583-601.
14 PipbergerHE,ArzbaecherRC,BersonAS.AmericanHeartAssociationCommitteeon Electrocardiography:recommendationsforstandardizationofleadsandofspecificationsfor instrumentsinelectrocardiographyandvectorcardiography.Circulation1975;52:11-31.
15 WorldHealthOrganisation(1981)RegionalOfficeforEurope.UsesoftheElectrocardiogram. ReportonaWHOstudy;CopenhagenEUROReportsandStudies37(projectICP/ATH003). WHO,Geneva
16 IEC60601-2-25:2011Medicalelectricalequipment-Part2-25:Particularrequirementsfor the basic safety and essential performance of electrocardiographs
*The12SLACSalgorithmisnotavailableinallGEHealthcareECGdevices. ContactyourGEHealthcareRepresentativeformoredetails.
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