New Electrocardiographic Algorithm for the Diagnosis of Acute Myocardial Infarction in Patients With Left Bundle Branch Block

Background Current electrocardiographic algorithms lack sensitivity to diagnose acute myocardial infarction (AMI) in the presence of left bundle branch block. Methods and Results A multicenter retrospective cohort study including consecutive patients with suspected AMI and left bundle branch block, referred for primary percutaneous coronary intervention between 2009 and 2018. Pre-2015 patients formed the derivation cohort (n=163, 61 with AMI); patients between 2015 and 2018 formed the validation cohort (n=107, 40 with AMI). A control group of patients without suspected AMI was also studied (n=214). Different electrocardiographic criteria were tested. A total of 484 patients were studied. A new electrocardiographic algorithm (BARCELONA algorithm) was derived and validated. The algorithm is positive in the presence of ST deviation ≥1 mm (0.1 mV) concordant with QRS polarity, in any lead, or ST deviation ≥1 mm (0.1 mV) discordant with the QRS, in leads with max (R|S) voltage (the voltage of the largest deflection of the QRS, ie, R or S wave) ≤6 mm (0.6 mV). In both the derivation and the validation cohort, the BARCELONA algorithm achieved the highest sensitivity (93%-95%), negative predictive value (96%-97%), efficiency (91%-94%) and area under the receiver operating characteristic curve (0.92-0.93), significantly higher than previous electrocardiographic rules (P<0.01); the specificity was good in both groups (89%-94%) as well as the control group (90%). Conclusions In patients with left bundle branch block referred for primary percutaneous coronary intervention, the BARCELONA algorithm was specific and highly sensitive for the diagnosis of AMI, leading to a diagnostic accuracy comparable to that obtained by ECG in patients without left bundle branch block

Rediseño de una embarcación de recreo de menos de 24 metros para pasar a consumir LNG como combustible

El objetivo del presente trabajo es diseñar un tanque de LNG aplicando el código de diseño de ASME para que cumpla con la directiva de equipos a presión 2014/68/UE. Es decir, se realizará el diseño y se elaborará una memoria técnica indicando el contenido que debe incluir para obtener el marcado CE. El depósito de LNG se diseñará para una embarcación de menos de 24 metros de combustible convencional. Es decir, se le cambiará el sistema de combustible para que pueda operar con LNG. Una vez dimensionado el tanque, se determinarán las características físicas que establece el código. Para ello se elaborará una memoria técnica. Por último, se realizará una descripción del proceso de fabricación, así como de los requerimientos que establece la directiva para que cumpla con ella

Rediseño de una embarcación de recreo de menos de 24 metros para pasar a consumir LNG como combustible

El objetivo del presente trabajo es diseñar un tanque de LNG aplicando el código de diseño de ASME para que cumpla con la directiva de equipos a presión 2014/68/UE. Es decir, se realizará el diseño y se elaborará una memoria técnica indicando el contenido que debe incluir para obtener el marcado CE. El depósito de LNG se diseñará para una embarcación de menos de 24 metros de combustible convencional. Es decir, se le cambiará el sistema de combustible para que pueda operar con LNG. Una vez dimensionado el tanque, se determinarán las características físicas que establece el código. Para ello se elaborará una memoria técnica. Por último, se realizará una descripción del proceso de fabricación, así como de los requerimientos que establece la directiva para que cumpla con ella

New Electrocardiographic Algorithm for the Diagnosis of Acute Myocardial Infarction in Patients With Left Bundle Branch Block

Current electrocardiographic algorithms lack sensitivity to diagnose acute myocardial infarction () in the presence of left bundle branch block. A multicenter retrospective cohort study including consecutive patients with suspected and left bundle branch block, referred for primary percutaneous coronary intervention between 2009 and 2018. Pre-2015 patients formed the derivation cohort (n=163, 61 with ); patients between 2015 and 2018 formed the validation cohort (n=107, 40 with ). A control group of patients without suspected was also studied (n=214). Different electrocardiographic criteria were tested. A total of 484 patients were studied. A new electrocardiographic algorithm ( algorithm) was derived and validated. The algorithm is positive in the presence of deviation ≥1 mm (0.1 mV) concordant with polarity, in any lead, or deviation ≥1 mm (0.1 mV) discordant with the , in leads with max (R $s ) voltage (the voltage of the largest deflection of the , ie, R or S wave) ≤6 mm (0.6 mV). In both the derivation and the validation cohort, the algorithm achieved the highest sensitivity (93%-95%), negative predictive value (96%-97%), efficiency (91%-94%) and area under the receiver operating characteristic curve (0.92-0.93), significantly higher than previous electrocardiographic rules (P <0.01); the specificity was good in both groups (89%-94%) as well as the control group (90%). In patients with left bundle branch block referred for , the algorithm was specific and highly sensitive for the diagnosis of , leading to a diagnostic accuracy comparable to that obtained by in patients without left bundle branch block