A Novel ECG Score for Predicting Left Ventricular Systolic Dysfunction in Stable Angina: A Pilot Study

Background: Left ventricular systolic dysfunction (LVSD) is a major determinant of prognosis in patients with ischemic heart disease. Electrocardiography (ECG) is widely available, inexpensive, and may aid in identifying patients at risk. We hypothesized that a composite score derived from multiple established ECG markers could improve the detection of LVSD in patients with stable angina. Methods: In this single-center, cross-sectional study, 177 patients undergoing elective coronary angiography for stable angina were included. Patients were classified as LVSD-negative (n = 123) or LVSD-positive (n = 54) based on echocardiographic ejection fraction. ECG parameters, including fragmented QRS, pathologic Q waves, R-wave peak time, QRS duration, and frontal QRS-T angle, were assessed. Independent predictors of LVSD were identified using multivariate logistic regression. A composite ECG score was constructed by assigning one point to each abnormal parameter. Model robustness was evaluated using bootstrap resampling (1000 iterations) and 10-fold cross-validation. Results: Multivariable analysis identified prior stent implantation, fragmented QRS, pathological Q waves, R-wave peak time, frontal QRS-T angle (log-transformed), and QRS duration as independent predictors of LVSD. ROC analysis demonstrated good discriminatory performance for R-wave peak time (AUC 0.804), QRS duration (AUC 0.649), and frontal QRS-T angle (AUC 0.825) measurements. The composite ECG score showed a stepwise association with LVSD: a score of ≥2 yielded high sensitivity (88%) and negative predictive value (97%), whereas a score of ≥3 provided high specificity (100%) and positive predictive value (100%). Bootstrap resampling and cross-validation confirmed model stability and strong discriminatory performance (mean AUC, 0.964; accuracy, 0.91). Conclusions: A simple composite ECG score integrating multiple established ECG markers is associated with the robust detection of LVSD in patients with stable angina. Although not a substitute for echocardiography, this score may support early risk stratification and help identify patients who warrant further imaging evaluations. External validation in larger and more diverse populations is required before routine clinical implementation of this model.