Computerized orthogonal electrocardiogram: Relation of QRS forces to left ventricular ejection fraction

Gottwik, Martin; Parisi, Alfred F.; Askenazi, Joseph; McCaughan, Donald

doi:10.1016/0002-9149(78)90125-x

Cited by 31 publications

(5 citation statements)

References 21 publications

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“…Although the value of the ECG in the diagnosis of structural heart disease, such as ischemic heart disease, is well established, its utility in diagnosing LVSD is less so. The ability of the ECG to predict the presence of LVSD has been evaluated in a number of studies involving ECGs read both by humans and machine [ 1 , 21 , 22 , 23 ]. However with both types of readings the prediction of LVSD was ultimately allowed by indirect means, e.g., the presence of atrial fibrillation, or previous myocardial infarction or major nonspecific ECG abnormalities such as axis deviation or left bundle branch block (LBBB).…”

Section: Discussionmentioning

confidence: 99%

“…Whilst many ECG parameters, such as the QRS duration [ 24 ], are known to alter with left ventricular dilation and dysfunction, modest changes in these continuous parameters are not easily perceptible to human readers. Computerised ECG scores have been described since the 1970s and 1980s and initially showed, in small populations of patients with ischemic cardiomyopathy, remarkable sensitivity (93%) and specificity (88%) for LVSD as well as strong correlations with LVEF (r = 0.8 to 0.9) [ 21 , 22 ]. However, the performance of these older, strictly conventional ECG scores was notably diminished during subsequent attempts at validation with further (larger N ) cases of ischemic cardiomyopathy [ 25 ], such that they were never translated into clinical practice [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

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Advanced Electrocardiography Identifies Left Ventricular Systolic Dysfunction in Non-Ischemic Cardiomyopathy and Tracks Serial Change over Time

Johnson

Neilson

et al. 2015

JCDD

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Advanced Electrocardiography Identifies Left Ventricular Systolic Dysfunction in Non-Ischemic Cardiomyopathy and Tracks Serial Change over Time

Johnson

Neilson

et al. 2015

JCDD

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“…A significant correlation between the sum of the R wave amplitudes on the orthogonal ECG and LVEF, meaning that the ejection fraction could be estimated on the ECG, was first reported by Gottwlk et al [29] in 1978. However, in 1983, Luweart et al [30] advised against use of the ∑ R or ∑ QRS alone to estimate ejection fraction because these values could be influenced by many factors, such as left intraventricular pressure, left ventricular wall kg/m 2 .…”

Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Predictive Value of QRS Fraction for Cardiovascular Death in Patients with Heart Failure: A Prospective Cohort Study in Acute Decompensated Heart Failure (Heb-ADHF)

Cui¹,

Liu²,

Geng³

et al. 2022

Rev. Cardiovasc. Med.

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Background:The QRS fraction is the ratio of the total amplitude of R waves to the total amplitude of QRS complexes ( ∑ R/QRS) on a 12-lead electrocardiogram. Our group has previously proposed calculation of the QRS fraction as a simple method for estimation of left ventricular ejection fraction. In this study, we explored the ability of the QRS fraction to predict cardiovascular death in patients with heart failure. Methods: The study had a prospective, observational design and collected epidemiological and follow-up data for 1715 patients with heart failure who were inpatients in the

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“…14 After hospital discharge all patients were followed at regular intervals. The median follow up was 10 (range [6][7][8][9][10][11][12][13][14] 15-u a, 60 the fraction of correct classification of patients who satisfy the "endpoint" criteria, and specificity the fraction of correct classification of all patients who satisfy the "non-endpoint" criteria. These curves, when generated for different tests, provide a direct comparison of the various test results over the entire range of measurements.…”

Section: Al3 Andmentioning

confidence: 99%

Limitations of a QRS scoring system to assess left ventricular function and prognosis at hospital discharge after myocardial infarction.

Fioretti¹,

Brower²,

Lazzeroni³

et al. 1985

Heart

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SUMMARY The value of a QRS scoring system derived from 12 lead electrocardiograms to estimate left ventricular ejection fraction was assessed in a prospective study of 285 hospital survivors of myocardial infarction. In these patients both the QRS score and ejection fraction were measured by radionuclide ventriculography at discharge. The correlation between ejection fraction and QRS score was weak. In 22 patients who died during six to 12 months follow up the ability of the ejection fraction and QRS score to predict mortality was assessed in terms of sensitivity, specificity, predictive value of a positive and negative test, and efficiency. For ejection fraction <40% and a QRS score >6 sensitivity was respectively 73% and 64%, specificity 73% and 56%, predictive value of a positive test 18% and 11%, predictive value of a negative test 97% and 95%, and efficiency 73% and 56%.Both ejection fraction and QRS score may be used to identify patients at low and high risk during one year follow up, but, contrary to initial expectations, the QRS score appears to be of little value in estimating ejection fraction and is less accurate than ejection fraction in predicting late survival in hospital survivors of myocardial infarction. For this group of 285 patients, the mean age was 57 (range 22-82) years, 82% were male, and 27% had a previous myocardial infarction. On admission 37% had an acute anterior myocardial infarction, 38% an inferior-posterior myocardial infarction, and 25% non-Q wave myocardial infarction; 74% were in Killip clinical class I. The median hospital stay was 13 (range 7-58) days.To determine the QRS score, standard 12 lead electrocardiograms were obtained on a three channel Hewlett Packard 1513 A automatic cardiograph recorder at a paper speed of 25 mm/s on the day of hospital discharge or one day before. Conventional speed and sensitivity were used, because they are advocated for current clinical use. The QRS scoring system as described by Wagner et a12 was applied (Table 1). The calculations were validated by the independent measurement of the score from a random sample of 39 electrocardiograms by the original author of the score, who was blinded to our measurements; the independent measurements showed no significant difference from the study readings (study score mean (SD) 4-8 (3.8) vs independent score 5.4 (3.9)). The

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Computerized orthogonal electrocardiogram: Relation of QRS forces to left ventricular ejection fraction

Cited by 31 publications

References 21 publications

Advanced Electrocardiography Identifies Left Ventricular Systolic Dysfunction in Non-Ischemic Cardiomyopathy and Tracks Serial Change over Time

Advanced Electrocardiography Identifies Left Ventricular Systolic Dysfunction in Non-Ischemic Cardiomyopathy and Tracks Serial Change over Time

Predictive Value of QRS Fraction for Cardiovascular Death in Patients with Heart Failure: A Prospective Cohort Study in Acute Decompensated Heart Failure (Heb-ADHF)

Limitations of a QRS scoring system to assess left ventricular function and prognosis at hospital discharge after myocardial infarction.

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