The clinical applications of cardiogoniometry in cardiovascular disease

Brown, Oliver Ian

July 2016

Thesis or dissertation

© 2016 Oliver Ian Brown. All rights reserved. No part of this publication may be reproduced without the written permission of the copyright holder.

Cardiogoniometry (CGM) is a method of 3-dimensional electrocardiographic assessment which has primarily been investigated to evaluate its role in diagnosing patients with suspected coronary artery disease (CAD). Previous work has suggested it has considerable diagnostic ability at identifying patients with both stable CAD and those with acute coronary syndrome (ACS). However, previous studies which investigated the diagnostic performance of CGM in stable CAD did not use robust measures to accurately identify patients with physiologically significant coronary ischaemia. Furthermore, although the ability of CGM to identify specific lesions in stable CAD has been evaluated, to the best of our knowledge no research has been performed to assess the ability of CGM to detect the site of the culprit lesion in patients with non-ST elevation myocardial infarction. The first two studies of this thesis aim to address these two questions about the role of CGM in patients with CAD.

Cardiac resynchronisation therapy (CRT) is a treatment used in patients with heart failure and left bundle branch block which attempts to restore synchronous contraction of the ventricles by pacing both the left and right ventricle together. Unfortunately, 25% of patients do not gain a clinical benefit from CRT, such patients are classed as ‘non-responders’. Many methods have been proposed to optimise CRT for ‘non-responders’, however, no specific optimisation method has yet been identified which significantly improves the long term benefit of CRT in non-responders. The detailed spatial and temporal information on cardiac electrical activity that CGM provides suggests that CGM may have a role in the optimisation of CRT. The aim of the third study in this thesis is to evaluate whether CGM can detect changes to CRT pacing settings, in view of developing a method of CRT optimisation using CGM.

Hull York Medical School, The University of Hull and The University of York
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