Evaluation of a Wrist-Worn Device for ECG-Based Detection of Acute Myocardial Infarction

Objective: To determine whether a two-lead ECG (wECG), acquired using a self-applicable, wrist-worn device, provides diagnostic value in acute myocardial infarction (AMI) detection. Methods: Seventy-one patients with AMI, 26 with other cardiovascular diseases (CVDs), and 54 healthy controls were enrolled in the study. To acquire lead I, one electrode of the wrist-worn device was touched with the index finger of the opposite hand, while another lead was acquired by touching the electrode on the strap to a specific part of the body. The diagnostic value of the wECG is evaluated either directly or through synthesis of the standard 12-lead ECG using an echo state network. Results: Using the standard ECG, an AMI detector based on a convolutional neural network yields a sensitivity of 0.86 and a specificity of 0.71; the corresponding figures for blinded cardiologist diagnosis are 0.77/0.88. Using the synthesized ECG, the V3 electrode touch site yields the best performance, with a sensitivity/specificity of 0.84/0.71 for AMI detection and 0.67/0.86 for cardiologist diagnosis. Compared to the synthesized ECG across all touch sites, use of the wECG results in a substantially lower sensitivity, reduced by 0.12–0.13, while the specificity is comparable or slightly higher. Implementation of a two-stage approach, consisting of detector-based screening followed by cardiologist review of positive cases, results in correct decisions in 63% of the AMI cases using either the synthesized ECG or the wECG. Conclusion: The two-lead ECG acquired with a wrist-worn device offers diagnostic value and enables screening for AMI.