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Clinical Investigations: CARDIOLOGY |

A Comparison of 2-Lead, 6-Lead, and 12-Lead ECGs in Patients With Changing Edematous States*: Implications for the Employment of Quantitative Electrocardiography in Research and Clinical Applications

John E. Madias
Author and Funding Information

*From the Division of Cardiology, Elmhurst Hospital Center, Elmhurst, NY.

Correspondence to: John E. Madias, MD, Professor of Medicine (Cardiology), Division of Cardiology, Elmhurst Hospital Center, 79–01 Broadway, Elmhurst, NY 11373; e-mail: madiasj@nychhc.org



Chest. 2003;124(6):2057-2063. doi:10.1378/chest.124.6.2057
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Objective: Precordial ECGs reveal significant intrasubject variability due to the inexact employment of the recommended V1-V6 chest landmarks. Also, as per the Einthoven law, the six limb leads can be derived from leads 1 and 2. The purpose of this study was to evaluate whether the 12-lead ECG could be substituted by ECG sets with a limited number of leads.

Materials and methods: The performance of three ECG systems (ie, the 12-lead ECG, a 6-lead ECG comprising the limb leads, and a 2-lead ECG comprising exclusively leads 1 and 2) was evaluated in data from 28 patients with anasarca (AN), 28 control patients, 10 patients who had undergone hemodialysis, and 3 patients with idiopathic dilated cardiomyopathy.

Results: Linear regression analyses of changes in ECG data with the weight gain of patients with AN and the intercorrelations of the three ECG systems in the various patient subgroups were found to be statistically significant at p = 0.0005 and r values ranging from 0.61 to 0.99, which are suggestive of good/excellent correlations. However, regression analyses of peak weight (PW) gain with changes in the 2-lead ECG (r = 0.43; p = 0.02) and 6-lead ECG (r = 0.48; p = 0.01), and half of PW gain and 12-lead ECG (r = 0.41; p = 0.03), 6-lead ECG (r= 0.18; p = 0.35), and 2-lead ECG (r = 0.43; p = 0.02) revealed poor correlations.

Conclusion: ECG systems, comprising 2 or 6 leads, can be substituted for the 12-lead ECG for certain clinical and research applications (pertaining to the amplitude of QRS complexes), attesting to the inherent redundancy of the information from the 12-lead ECG.

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