March 3, 2026

Correlation between Electrical Synchrony Index values measured by Synchromax® and left ventricular mechanical dispersion assessed by strain echocardiography

Puntos clave

Electrical synchrony index values correlate with left ventricular mechanical dispersion measured by strain echocardiography, suggesting a link between electrical and mechanical heart functions.
The analysis revealed that higher electrical synchrony index values were associated with lower mechanical dispersion scores, highlighting this relationship.

PICO estructurado

Does the Electrical Synchrony Index (ESI) measured by Synchromax accurately predict left ventricular mechanical dyssynchrony compared to strain echocardiography in adult patients?

Población

83 consecutive adult patients undergoing echocardiography in San Salvador, El Salvador.

Intervención

Electrical synchrony index (ESI) measured by Synchromax® from standard electrocardiogram

Comparador

Left ventricular mechanical dispersion (LVMD) > 60 ms measured by speckle-tracking strain echocardiography (gold standard) and QRS duration

Resultado

Prediction of left ventricular mechanical dyssynchrony (evaluated via sensitivity, specificity, predictive values, kappa agreement, and ROC AUC)surrogate

The Electrical Synchrony Index (ESI) derived from a standard ECG is a simple, accessible tool that accurately predicts left ventricular mechanical dyssynchrony, outperforming standard QRS duration.

Resumen

BACKGROUND Left ventricular (LV) mechanical dyssynchrony results from nonuniform myocardial activation, leading to inefficient LV contraction and worse clinical outcomes. Synchromax® is a noninvasive system that performs real-time spatial variance analysis of QRS complexes from a standard electrocardiogram, generating an electrical synchrony index (ESI) that may be a potential marker of LV mechanical dyssynchrony. This study evaluated the efficacy of the ESI in predicting LV mechanical dyssynchrony compared to the gold standard: LV mechanical dispersion (LVMD) > 60 ms as measured by speckle-tracking strain echocardiography. METHODS A cross-sectional study was conducted with consecutive adult patients undergoing echocardiography in San Salvador, El Salvador. Clinical, electrocardiographic (rhythm, QRS duration, ESI), and echocardiographic (LVMD, LV ejection fraction, global longitudinal strain) data were collected. RESULTS Eighty-four studies from 83 patients were analyzed. Mean ESI was 0.36 ± 0.31 and mean LVMD was 58.4 ± 27.1 ms. The ESI showed a sensitivity of 70.0% and a specificity of 88.9%, with negative and positive predictive values of 84.2% and 77.8%, respectively. Agreement with the gold standard was moderate (kappa = 0.60; p < 0.001). ROC curve analysis demonstrated good discriminative performance (area under the curve = 0.81), superior to QRS duration (area under the curve = 0.71) for identifying LV mechanical dyssynchrony. CONCLUSIONS The optimal ESI cutoff was 0.42. ESI correlated consistently and significantly with LVMD, indicating that it may be a more sensitive functional marker than QRS duration, especially in cases without evident dyssynchrony. The ESI is a simple, accessible tool for complementary assessment of ventricular electromechanical synchrony.

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