Failure of the omnicardiogram to predict coronary artery disease in patients with normal resting electrocardiograms

Summary Seventy-two male patients over the age of 35 had normal resting twelve lead electrocardiograms (ECGs). All patients were studied by invasive techniques including complete right and left sided cardiac catheterization, selective coronary arteriography, and left ventricular angiography. All patients had been referred because of chest pain with a presumed diagnosis of coronary artery obstruction and myocardial ischemia. Omnicardiograms were generated from the twelve lead ECGs and diagnosed as “abnormal” or “normal” by observers having no knowledge of the cardiac catheterization fidings. Of 72 patients studied, 21 were free of coronary artery disease. Of these, 14 (66%) had “abnormal” omnicardiographic reports. Seven (33%) had “normal” omnicardiograms, indicating an incidence of false positive “abnormal” omnicardiographic reports as 66%. Fifty-one patients had hemodynamically significant coronary artery disease. In this group, 19 (38%) were reported as “normal” by omnicardiograman incidence of false negative diagnosis of 38%. When the patients with coronary artery disease were classified as to single, double, or triple coronary obstruction, it was evident that the omnicardiogram had failed to separate patients with more extensive disease. Of the 32 patients with “abnormal” omnicardiograms, 56% had double or triple vessel disease, while of the 19 patients with “normal” omnicardiograph reports, 78% had double or triple vessel disease. Similarly, the omnicardiograms failed to identify the patients with abnormal left ventricular function as determined by left ventricular angiography. Of 19 patients with coronary artery disease and “normal” omnicardiograms, only 8 (42%) had normal ventricular angiography. However, of the 32 patients with coronary disease and “abnormal” omnicardiograms, only 11 (34%) had abnormal ventriculogram. The omnicardiogram cannot be considered a useful technique for predicting the presence or severity of coronary artery disease or for the identification of abnormal left ventricular function in patients with known coronary artery disease.