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Published on: October 28, 2020
Validation of electrocardiographic criteria for identifying left ventricular dysfunction in patients with previous
Gopi Krishna Panicker1, Dhiraj D Narula2, Christine M Albert3,4
1Cardiac Safety Services, IQVIA, Mumbai, India.
Insights
Electrocardiogram (ECG) criteria do not effectively screen for reduced left ventricular ejection fraction (LVEF). Specific ECG findings showed high specificity but low sensitivity for identifying patients with LVEF ≤40%.
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Tools
Background:
- Previous studies identified 11 electrocardiogram (ECG) criteria correlating with reduced left ventricular ejection fraction (LVEF).
- These criteria have not been directly compared in a single study for their screening efficacy.
- Cardiac magnetic resonance (CMR) imaging is used to estimate LVEF.
Purpose of the Study:
- To evaluate the diagnostic performance of 11 ECG criteria as a screening tool for reduced LVEF.
- To compare the sensitivity, specificity, and predictive values of these ECG criteria in patients with previous myocardial infarction (MI).
Main Methods:
- Analysis of ECG and CMR data from 548 patients with prior MI.
- Assessment of 11 ECG criteria for identifying patients with LVEF ≤30% and LVEF ≤40%.
- Calculation of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for each criterion.
Main Results:
- Mean LVEF was 40%; 48.2% of patients had LVEF ≤40% and 17.5% had LVEF ≤30%.
- Six criteria showed association with lower LVEF but had poor sensitivity for LVEF ≤30% or ≤40%.
- Goldberger's third criterion and specific QRS duration combinations demonstrated high specificity for LVEF ≤40% but were infrequent.
Conclusions:
- None of the evaluated ECG criteria performed adequately as a screening test for reduced LVEF.
- While some criteria showed high specificity for LVEF ≤40%, their low prevalence limits their utility.
- Further research is needed to identify ECG criteria that can effectively detect left ventricular dysfunction.
Background:
Eleven criteria correlating electrocardiogram (ECG) findings with reduced left ventricular ejection fraction (LVEF) have been previously published. These have not been compared head-to-head in a single study. We studied their value as a screening test to identify patients with reduced LVEF estimated by cardiac magnetic resonance (CMR) imaging.
Methods:
ECGs and CMR from 548 patients (age 61 + 11 years, 79% male) with previous myocardial infarction (MI), from the DETERMINE and PRE-DETERMINE studies, were analyzed. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of each criterion for identifying patients with LVEF ≤ 30% and ≤ 40% were studied. A useful screening test should have high sensitivity and NPV.
Results:
Mean LVEF was 40% (SD = 11%); 264 patients (48.2%) had LVEF ≤ 40%, and 96 patients (17.5%) had LVEF ≤ 30%. Six of 11 criteria were associated with a significant lower LVEF, but had poor sensitivity to identify LVEF ≤ 30% (range 2.1%-55.2%) or LVEF ≤ 40% (1.1%-51.1%); NPVs were good for LVEF ≤ 30% (range 82.8%-85.9%) but not for LVEF ≤ 40% (range 52.1%-60.6%). Goldberger's third criterion (RV4/SV4 < 1) and combinations of maximal QRS duration > 124 ms + either Goldberger's third criterion or Goldberger's first criterion (SV1 or SV2 + RV5 or RV6 ≥ 3.5 mV) had high specificity (95.4%-100%) for LVEF ≤ 40%, although seen in only 48 (8.8%) patients; predictive values were similar on subgroup analysis.
Conclusions:
None of the ECG criteria qualified as a good screening test. Three criteria had high specificity for LVEF ≤ 40%, although seen in < 9% of patients. Whether other ECG criteria can better identify LV dysfunction remains to be determined.
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