Analysis of Surface EKG Signals to Identify Myocardial Dysfunction in Patients at Risk for Coronary Artery Disease

Background Myocardial ischemia is caused by myocardial oxygen supply and demand mismatch.
Despite that coronary artery disease (CAD) is the major cause of myocardial ischemia, the
symptoms may occur even in the absence of significant CAD. One of the mechanisms suggested
for myocardial ischemia in these patients is microvascular ischemia (i.e. mismatch in
microscopic vessels), affecting the myocardium (i.e. heart muscle) at the cellular level.

A novel electrocardiographic recording method, the iECG is capable of capturing and
amplifying signals from the cellular level that are much lower biologic signals than those
processed by a traditional electrocardiogram (ECG). These recordings focus on early detection
of myocardial abnormalities by non-linear analysis of electrical activity and physiological
phenomenon. This novel assessment might be capable of detecting subclinical myocardial
dysfunction in a variety of heart diseases.

Specific Aims

Aim#1: Study the feasibility of detection of CAD using iECG compared to computed tomographic
coronary angiography (CTA).

Aim#2: Study the association between patterns of iECG and myocardial dysfunction in patients
without CAD compared to echocardiography.

Aim#3: Study the effect of changes in iECG output on future outcomes of CAD and need for
revascularization.

Inclusion Criteria:

- Sinus rhythms

- Age>18 years

- Both genders

Exclusion Criteria:

- Acute coronary syndromes(ACS)

- Contraindications to the administration of iodinated contrast

- Pregnancy

- Coronary artery bypass surgery (CABG)

- History of cardiac valvular replacement

- Implanted cardiac pacemaker

- Chest deformities

- Unwilling or unable to provide informed consent for study participation

- Enrolled in another clinical study