Prognostic value of Goldberger's electrocardiographic criteria for left ventricular dysfunction

The ability of the Goldberger electrocardiographic (ECG) triad criteria to detect left ventricular dysfunction (LVD) is well-established. However, the prognostic significance of this triad as a predictor of poor outcomes is not known.

We explored the association between the Goldberger ECG-LVD triad with all-cause mortality and cardiovascular mortality in the general population.

This analysis included 8426 participants (60.5 ± 13.6 years, 51.5% women, 50% non-Hispanic white) from the Third National Health and Nutrition Examination Survey. The Goldberger ECG-LVD triad was defined as follows: high precordial QRS voltage (SV1 or SV2 + RV5 or RV6 ≥ 3500 μV); low limb lead QRS voltage (mean QRS amplitude in each of the limb leads ≤800 μV); and poor R wave progression (RV4/SV4 < 1). Mortality was ascertained using the National Death Index.

At baseline, 1384 (47.3%) of the participants had at least one of the criteria of Goldberger triad (1193 had only one and 191 participants had 2 or more). During a median follow up of 13.8 years, 3184 deaths occurred, of which 1405 were cardiovascular. In multivariable-adjusted Cox proportional hazards models, presence of at least one of the Goldberger triad criteria (vs. none) was associated with increased risk of all-cause (HR 1.17, 95% CI 1.08-1.26, p ≤0.0001) and cardiovascular mortality (1.19, 1.06-1.33, p = 0.003).

The Goldberger ECG-LVD triad for left ventricular dysfunction may offer prognostic value in addition to its reported diagnostic utility.