Key result
Advanced ECG scoring detected left ventricular systolic dysfunction with 95% sensitivity and 95% specificity, compared to 90% sensitivity and 63% specificity for human readers.
Why the study?
Does advanced ECG (A-ECG) scoring accurately detect left ventricular systolic dysfunction and track serial changes in patients with non-ischemic cardiomyopathy compared to human readers?
Case-Control (n=79)
Does advanced ECG (A-ECG) scoring accurately detect left ventricular systolic dysfunction and track serial changes in patients with non-ischemic cardiomyopathy compared to human readers?
Absolute Event Rate: 95% vs 90%
Advanced ECG scoring provides high sensitivity and specificity for detecting left ventricular systolic dysfunction in non-ischemic cardiomyopathy, outperforming human readers and offering a potential low-cost tool for serial tracking.
May enhance LV systolic dysfunction detection; hypothesis-generating from case-control data and requires prospective validation.
Electrocardiogram (ECG)-based detection of left ventricular systolic dysfunction (LVSD) has poor specificity and positive predictive value, even when including major ECG abnormalities, such as left bundle branch block (LBBB) within the criteria for diagnosis. Although machine-read ECG algorithms do not provide information on LVSD, advanced ECG (A-ECG), using multiparameter scores, has superior diagnostic utility to strictly conventional ECG for identifying various cardiac pathologies, including LVSD. Methods: We evaluated the diagnostic utility of A-ECG in a case-control study of 40 patients with LVSD (LV ejection fraction < 50% by echocardiography), due to non-ischemic cardiomyopathy (NICM), and 39 other patients without LVSD. Diagnostic sensitivity and specificity for LVSD were determined after applying a previously validated probabilistic A-ECG score for LVSD to stored standard (10 s) clinical 12L ECGs. In 25 of the NICM patients who had serial ECGs and echocardiograms, changes in the A-ECG score versus in echocardiographic LV ejection fraction were also studied to determine the level of agreement between the two tests. Results: Analyses by A-ECG had a sensitivity of 95% for LVSD (93% if excluding N = 11 patients with LBBB) and specificity of 95%. In the 29 NICM patients without LBBB who had serial ECGs, sensitivity improved to 97% when all ECGs were considered. By comparison, human readers in a busy clinical environment had a sensitivity of 90% and specificity of 63%. A-ECG score trajectories demonstrated improvement, deterioration or no change in LVSD, which agreed with echocardiography, in 76% of cases (n = 25). Conclusion: A-ECG scoring detects LVSD due to NICM with high sensitivity and specificity. Serial A-ECG score trajectories also represent a method for inexpensively demonstrating changes in LVSD. A-ECG scoring may be of particular value in areas where echocardiography is unavailable, or as a gatekeeper for echocardiography.
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Johnson et al. (2015) conducted a case-control in Left ventricular systolic dysfunction in non-ischemic cardiomyopathy (n=79). Advanced ECG (A-ECG) scoring vs. Human readers was evaluated on Diagnostic sensitivity and specificity for LVSD. Advanced ECG scoring detected left ventricular systolic dysfunction with 95% sensitivity and 95% specificity, compared to 90% sensitivity and 63% specificity for human readers.
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