A 7-parameter advanced ECG score increased the sensitivity of resting ECG for identifying cardiac disease from 78% to 92% and specificity from 85% to 94% compared to conventional ECG.
Observational (n=1,023)
Single-blind
Yes
Does an advanced 12-lead ECG score improve the diagnostic accuracy for detecting CAD, LVH, and LVSD compared to strictly conventional 12-lead ECG in healthy controls and cardiac patients?
Advanced 12-lead ECG scoring significantly improves the sensitivity and positive predictive value for detecting coronary artery disease, left ventricular hypertrophy, and left ventricular systolic dysfunction compared to conventional ECG.
Absolute Event Rate: 92% vs 78%
p-value: p=<0.0001
BACKGROUND: Resting conventional 12-lead ECG has low sensitivity for detection of coronary artery disease (CAD) and left ventricular hypertrophy (LVH) and low positive predictive value (PPV) for prediction of left ventricular systolic dysfunction (LVSD). We hypothesized that a approximately 5-min resting 12-lead advanced ECG test ("A-ECG") that combined results from both the advanced and conventional ECG could more accurately screen for these conditions than strictly conventional ECG. METHODS: Results from nearly every conventional and advanced resting ECG parameter known from the literature to have diagnostic or predictive value were first retrospectively evaluated in 418 healthy controls and 290 patients with imaging-proven CAD, LVH and/or LVSD. Each ECG parameter was examined for potential inclusion within multi-parameter A-ECG scores derived from multivariate regression models that were designed to optimally screen for disease in general or LVSD in particular. The performance of the best retrospectively-validated A-ECG scores was then compared against that of optimized pooled criteria from the strictly conventional ECG in a test set of 315 additional individuals. RESULTS: Compared to optimized pooled criteria from the strictly conventional ECG, a 7-parameter A-ECG score validated in the training set increased the sensitivity of resting ECG for identifying disease in the test set from 78% (72-84%) to 92% (88-96%) (P < 0.0001) while also increasing specificity from 85% (77-91%) to 94% (88-98%) (P < 0.05). In diseased patients, another 5-parameter A-ECG score increased the PPV of ECG for LVSD from 53% (41-65%) to 92% (78-98%) (P < 0.0001) without compromising related negative predictive value. CONCLUSION: Resting 12-lead A-ECG scoring is more accurate than strictly conventional ECG in screening for CAD, LVH and LVSD.
Schlegel et al. (Mi,) führten eine Beobachtungsstudie zur koronaren Herzkrankheit, linksventrikulärer Hypertrophie und linksventrikulärer systolischer Dysfunktion (n=1.023) durch. Der fortschrittliche 12-Kanal-EKG (A-EKG) Score wurde im Vergleich zu optimierten aggregierten Kriterien aus streng konventionellem 12-Kanal-EKG auf die Sensitivität zur Identifizierung von Krankheiten im Testset (p=<0,0001) bewertet. Ein 7-Parameter fortschrittlicher EKG-Score erhöhte die Sensitivität des Ruhe-EKG zur Identifizierung von Herzerkrankungen von 78 % auf 92 % und die Spezifität von 85 % auf 94 % im Vergleich zum konventionellen EKG.