Does an ECG-based screening algorithm accurately detect left ventricular systolic dysfunction in the elderly?
An ECG-based screening algorithm, potentially combined with NT-proBNP, can effectively identify elderly patients who require diagnostic echocardiography for left ventricular systolic dysfunction.
AIMS: Due to the demographic development there is an increasing number of senior citizens with left ventricular systolic dysfunction (LVSD), defined as ejection fraction (EF) 35 pmol/L. When APL was absent, NT-proBNP had discriminatory value regarding LVSD in the presence of Q-waves or QRS duration > 120 ms. Algorithms to screen for LVSD had sensitivity >90% and specificity >80% and claimed at least one of five (A/P/L/Q/D), one of 4 (A/P/L/Q), or one of three (A/Q/D) ECG changes. The optimal algorithm to reduce the need for diagnostic echocardiographies included four (A/P/L/Q) ECG changes and measurement of NT-proBNP when Q-waves were the only ECG change present. CONCLUSIONS: Ninety percent of LVSD may be detected, and when there is atrial fibrillation, pacing or LBBB, or QRS ≥ 120 ms/Q-waves and NT-proBNP>35 pmol/L, a diagnostic echocardiography should be considered.
Olesen et al. (Fri,) studied this question.