Smartphone ECG for evaluation of STEMI: Results of the ST LEUIS Pilot Study


© 2015 Elsevier Inc. All rights reserved.Background 12-lead ECG is a critical component of initial evaluation of cardiac ischemia, but has traditionally been limited to large, dedicated equipment in medical care environments. Smartphones provide a potential alternative platform for the extension of ECG to new care settings and to improve timeliness of care. Objective To gain experience with smartphone electrocardiography prior to designing a larger multicenter study evaluating standard 12-lead ECG compared to smartphone ECG. Methods 6 patients for whom the hospital STEMI protocol was activated were evaluated with traditional 12-lead ECG followed immediately by a smartphone ECG using right (VnR) and left (VnL) limb leads for precordial grounding. The AliveCor™ Heart Monitor was utilized for this study. All tracings were taken prior to catheterization or immediately after revascularization while still in the catheterization laboratory. Results The smartphone ECG had excellent correlation with the gold standard 12-lead ECG in all patients. Four out of six tracings were judged to meet STEMI criteria on both modalities as determined by three experienced cardiologists, and in the remaining two, consensus indicated a non-STEMI ECG diagnosis. No significant difference was noted between VnR and VnL. Conclusions Smartphone based electrocardiography is a promising, developing technology intended to increase availability and speed of electrocardiographic evaluation. This study confirmed the potential of a smartphone ECG for evaluation of acute ischemia and the feasibility of studying this technology further to define the diagnostic accuracy, limitations and appropriate use of this new technology.






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Publication Info

Muhlestein, Joseph Boone, Viet Le, David Albert, Fidela Ll Moreno, Jeffrey L Anderson, Frank Yanowitz, Robert B Vranian, Gregory W Barsness, et al. (2015). Smartphone ECG for evaluation of STEMI: Results of the ST LEUIS Pilot Study. Journal of Electrocardiology, 48(2). pp. 249–259. 10.1016/j.jelectrocard.2014.11.005 Retrieved from

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Harry Wells Severance

Adjunct Assistant Professor in the Department of Medicine

Site Principle Investigator: PROspective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE) prospective, randomized, multi-center clinical trial:

Principle Investigator - Duke E.D. Site - "Speed" Study. Pilot phase of Gusto IV. Investigating Abciximab (a GP IIb-IIIa inhibitor) in combination with rapid access to cardiac cath. Funded through Duke Clinical Research Institute. Multi-center trial.

Principle Investigator - Project: proposed mechanisms for afferent pain transmission from myocardial cells to pain centers. Purpose is to identify potential biochemical markers for early anginal presentations. Funded: grants received from Merck & Co. and Roche-Boehringer-Mannheim. Pilot phase paper - in preparation.

Other Interest Areas:
Wounding and medical management of penetrating injuries derived from firearms and blast-related injuries.

Impact of Observation/short-stay strategies on clinical care and inpatient/outpatient systems.

Impact of Emerging Viral Threats on clinical management and social/economic/political systems,

Acute Cardiology - Chest Pain Presentations 
Evolving Technology and AI in improving clinical care/management


N. Alejandro (Alex) Barbagelata

Adjunct Professor in the Department of Medicine

Medical degree at the University of Buenos Aires. Residency/Cardiology Fellowship at the Sanatorio Guemes/Favaloro Foundation. Cardiac cath fellow at the Sanatorio Guemes. International Scholar in Artificial Organs at the Cleveland Clinic. Duke Clinical Research Institute research fellow.

Faculty member in the Cardiology Division at the University of Texas Medical Branch with the rank of Assoc Professor of Medicine as CCU and Cardiac Cath Lab attending (invasive cardiologist) on all type of cardiovascular diseases Director or Associated Dir of the Advanced Heart Failure that included devices such as aquapheresis, 2.5 impella, Cardiac Power, and surgical such as being part of the approval team for destination therapy on Heart Mate II. UNOS primary physician in the Heart Transplant program 2011-2013. Current Adj Ast Professor Medicine/Cardiology at Duke University, member of the Board of Directors of DUCCS (a Duke Clinical Research organization). Director of the Advanced Heart Failure Postgraduate Program at the Universidad Catolica Argentina (UCA). Staff member Interventional Cardiology service at the Instituto del diagnostico y tratamiento, Buenos Aires, Argentina. 

Research Interest in Acute Myocardial Infarction and Heart Failure, percutaneous and surgical devices in heart failure. Early identification of STEMI such as criteria's for MI in LBBB ('s_criteria), new descriptors in Q wave/non Q wave, use of telemedicine for timeliness reperfusion. Co-editor of the book on “prehospital Management of Acute Myocardial Infarction” Member of the Int. Speaker Bureau AHA. Published more than 60 peer articles and more than 100 hundred abstract and speaker in a number of Scientific Meetings.

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