Introduction Cardiogoniometry (CGM) is a novel method of 3-D electrocardiographic (ECG) assessment, which has previously been shown to have significant diagnostic accuracy at identifying patients with stable coronary artery disease (CAD) and acute coronary syndromes (ACS). However, there is considerable variation of reported diagnostic accuracy of CGM depending on the gold standard test used to compare it to. The aim of our review is to identify what is diagnostic accuracy of CGM at identifying stable CAD and ACS, and identify other novel clinical applications of the technology.

Methods Using a pre-defined search strategy, electronic databases (MEDLINE and Embase) were searched for papers published between 1946–June 2015 and reference lists were pursued. For inclusion, papers had to be original research articles that investigated the clinical application of CGM. Sixteen publications were identified from our search; seven investigated the diagnostic accuracy of CGM to identify stable CAD; one investigated the diagnostic accuracy of CGM to identify ACS; one investigated CGM as a screening tool for cardiac allograft vasculopathy in heart transplant patients and seven investigated specific CGM parameters without commenting on diagnostic accuracy. If data was available and suitable for collation, it was pooled to calculate a comprehensive overview on markers of diagnostic accuracy, which included sensitivity and specificity.

Results When looking at studies investigating the diagnostic accuracy of CGM to identify stable CAD the figures of diagnostic accuracy varied: Sensitivity (64–89%) and specificity (64%–82%), however CGM consistently outperformed 12-lead ECG in terms of sensitivity (29–76%) and was comparable in terms of specificity (18–95%). The collated data pooled for our analysis included 772 patients, of which 473 had stable CAD. Our analysis showed CGM has a sensitivity of 70% and specificity of 82% at identifying stable CAD, being significantly more accurate than 12-lead ECG. The one study identified investigating the diagnostic accuracy of CGM to identify ACS included patients with non-ST segment elevation ACS and used multiple comparators including 12-lead ECG. It showed that the sensitivity and specificity of CGM to identify non-ST segment elevation ACS was 69% and 54% respectively, having significantly higher sensitivity than 12-lead ECG. The diagnostic accuracy reported for CGM to detect cardiac allograft vasculopathy was 100% and 88% respectively for sensitivity and specificity.

Conclusion CGM has superior diagnostic accuracy to 12-lead ECG at identifying patients with stable CAD and is significantly more sensitive than 12-lead ECG at identifying patients with non-ST segment elevation ACS. It may have an important role in screening patients with stable CAD and those with acute chest pain.