Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Mar;26(2):e12812.
doi: 10.1111/anec.12812. Epub 2020 Oct 30.

Validation of electrocardiographic criteria for identifying left ventricular dysfunction in patients with previous myocardial infarction

Gopi Krishna Panicker  1 , Dhiraj D Narula  2 , Christine M Albert  3   4 , Daniel C Lee  5 , Snehal Kothari  6 , Jeffrey J Goldberger  7 , Nancy Cook  3 , Andi Schaechter  5 , Eunjung Kim  3 , M Vinayaga Moorthy  3 , Julie Pester  3 , Neal A Chatterjee  8 , Alan H Kadish  9 , Dilip R Karnad  1
Affiliations

Validation of electrocardiographic criteria for identifying left ventricular dysfunction in patients with previous myocardial infarction

Gopi Krishna Panicker et al. Ann Noninvasive Electrocardiol. 2021 Mar.

Abstract

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.

Keywords: cardiac magnetic resonance imaging; coronary artery disease; electrocardiology; left ventricular ejection fraction; myocardial infarction.

PubMed Disclaimer

Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1
Distribution of left ventricular ejection fraction estimated from cardiac magnetic resonance (CMR) imaging in 548 patients included for the evaluation of ECG criteria
Figure 2
Figure 2
Negative predictive value (NPV), positive predictive value (PPV), specificity, and sensitivity and for each of the ECG criteria with LVEF cutoff of 30% (Panel a) and LVEF cutoff of 40% (Panel b). (N = 548)
See this image and copyright information in PMC

References

    1. Borlaug, B. A. , & Kass, D. A. (2011). Invasive hemodynamic assessment in heart failure. Cardiology Clinics, 29, 269–280. 10.1016/j.ccl.2011.03.003 - DOI - PubMed
    1. Bounous, E. P. Jr , Califf, R. M. , Harrell, F. E. Jr , Hinohara, T. , Mark, D. B. , Ideker, R. E. , Selvester, R. H. , & Wagner, G. S. (1988). Prognostic value of the simplified Selvester QRS score in patients with coronary artery disease. Journal of the American College of Cardiology, 11, 35–41. 10.1016/0735-1097(88)90163-5 - DOI - PubMed
    1. Chinitz, J. S. , Cooper, J. M. , & Verdino, R. J. (2008). Electrocardiogram voltage discordance: Interpretation of low QRS voltage only in the limb leads. Journal of Electrocardiology, 41, 281–286. 10.1016/j.jelectrocard.2007.12.001 - DOI - PubMed
    1. Cincin, A. , Ozben, B. , & Erdogan, O. (2012). Diagnostic utility of specific electrocardiographical parameters in predicting left ventricular function. Experimental & Clinical Cardiology, 17, 210–214. - PMC - PubMed
    1. Clinicaltrials.gov (2018). PRE‐DETERMINE Cohort Study – Clinicaltrials.gov [online]. Available at: https://clinicaltrials.gov/ct2/show/NCT01114269 [Accessed 01 Oct 2018].

Publication types

MeSH terms