Goldberger's Electrocardiographic Triad in Patients With Echocardiographic Severe Left Ventricular Dysfunction

Lopez, Christina; Ilie, Camelia C.; Glancy, D. Luke; Quintal, Roberto E.

doi:10.1016/j.amjcard.2011.10.053

Cited by 12 publications

(3 citation statements)

References 14 publications

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“…Only 10 patients of the 106 fulfilled all three criteria (sensitivity 9.4%, specificity 100%, positive predictive value 100%, and negative predictive value 27.8%) (Cincin et al., 2012). In another study, Lopez et al studied 51 patients with severe LV dysfunction defined by LVEF ≤ 20%; 7 of these had coronary artery disease (Lopez et al., 2012; Madias, 2012). The ECG triad was present in only in 1 out of their 51 patients.…”

Section: Discussionmentioning

confidence: 99%

Validation of electrocardiographic criteria for identifying left ventricular dysfunction in patients with previous myocardial infarction

Panicker

Narula

Albert

et al. 2020

Noninvasive Electrocardiol

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Background Eleven criteria correlating electrocardiogram (ECG) findings with reduced left ventricular ejection fraction (LVEF) have been previously published. These have not been compared head‐to‐head in a single study. We studied their value as a screening test to identify patients with reduced LVEF estimated by cardiac magnetic resonance (CMR) imaging. Methods ECGs and CMR from 548 patients (age 61 + 11 years, 79% male) with previous myocardial infarction (MI), from the DETERMINE and PRE‐DETERMINE studies, were analyzed. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of each criterion for identifying patients with LVEF ≤ 30% and ≤ 40% were studied. A useful screening test should have high sensitivity and NPV. Results Mean LVEF was 40% (SD = 11%); 264 patients (48.2%) had LVEF ≤ 40%, and 96 patients (17.5%) had LVEF ≤ 30%. Six of 11 criteria were associated with a significant lower LVEF, but had poor sensitivity to identify LVEF ≤ 30% (range 2.1%–55.2%) or LVEF ≤ 40% (1.1%–51.1%); NPVs were good for LVEF ≤ 30% (range 82.8%–85.9%) but not for LVEF ≤ 40% (range 52.1%–60.6%). Goldberger's third criterion (RV4/SV4 < 1) and combinations of maximal QRS duration > 124 ms + either Goldberger's third criterion or Goldberger's first criterion (SV1 or SV2 + RV5 or RV6 ≥ 3.5 mV) had high specificity (95.4%–100%) for LVEF ≤ 40%, although seen in only 48 (8.8%) patients; predictive values were similar on subgroup analysis. Conclusions None of the ECG criteria qualified as a good screening test. Three criteria had high specificity for LVEF ≤ 40%, although seen in < 9% of patients. Whether other ECG criteria can better identify LV dysfunction remains to be determined.

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Section: Discussionmentioning

confidence: 99%

Validation of electrocardiographic criteria for identifying left ventricular dysfunction in patients with previous myocardial infarction

Panicker

Narula

Albert

et al. 2020

Noninvasive Electrocardiol

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“…In 1982, Goldberger ( 19 ) described an ECG triad (“Goldberger’s triad”) consisting of (1) SV1 or SV2 + RV5 or RV6 of > 3.5 mV, (2) total QRS amplitude in each of the limb leads of 0.8 mV, and (3) R/S ratio of <1 in lead V4, which had a positive predictive value of >90% and specificity of >90% for detecting severe (LVEF < 35%) LV systolic dysfunction. Later, Lopez et al ( 20 ) suggested the utility of Goldberger's triad to identify patients with idiopathic DCM from hypertensive cardiomyopathy. The diagnostic role of this triad is currently well established only in patients with severe LV dysfunction, but it is unknown for patients with mild dysfunction or in the preclinical/asymptomatic stage.…”

Section: Dilated Cardiomyopathymentioning

confidence: 99%

The pivotal role of ECG in cardiomyopathies

Silvetti

Lanza

Romeo

et al. 2023

Front. Cardiovasc. Med.

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Cardiomyopathies are a heterogeneous group of pathologies characterized by structural and functional alterations of the heart. Recent technological advances in cardiovascular imaging offer an opportunity for deep phenotypic and etiological definition. Electrocardiogram (ECG) is the first-line diagnostic tool in the evaluation of both asymptomatic and symptomatic individuals. Some electrocardiographic signs are pathognomonic or fall within validated diagnostic criteria of individual cardiomyopathy such as the inverted T waves in right precordial leads (V1–V3) or beyond in individuals with complete pubertal development in the absence of complete right bundle branch block for the diagnosis of arrhythmogenic cardiomyopathy of the right ventricle (ARVC) or the presence of low voltages typically seen in more than 60% of patients with amyloidosis. Most other electrocardiographic findings such as the presence of depolarization changes including QRS fragmentation, the presence of epsilon wave, the presence of reduced or increased voltages as well as alterations in the repolarization phase including the negative T waves in the lateral leads, or the profound inversion of the T waves or downsloping of the ST tract are more non-specific signs which can however raise the clinical suspicion of cardiomyopathy in order to initiate a diagnostic procedure especially using imaging techniques for diagnostic confirmation. Such electrocardiographic alterations not only have a counterpart in imaging investigations such as evidence of late gadolinium enhancement on magnetic resonance imaging, but may also have an important prognostic value once a definite diagnosis has been made. In addition, the presence of electrical stimulus conduction disturbances or advanced atrioventricular blocks that can be seen especially in conditions such as cardiac amyloidosis or sarcoidosis, or the presence of left bundle branch block or posterior fascicular block in dilated or arrhythmogenic left ventricular cardiomyopathies are recognized as a possible expression of advanced pathology. Similarly, the presence of ventricular arrhythmias with typical patterns such as non-sustained or sustained ventricular tachycardia of LBBB morphology in ARVC or non-sustained or sustained ventricular tachycardia with an RBBB morphology (excluding the “fascicular pattern”) in arrhythmogenic left ventricle cardiomyopathy could have a significant impact on the course of each disease. It is therefore clear that a learned and careful interpretation of ECG features can raise suspicion of the presence of a cardiomyopathy, identify diagnostic “red flags” useful for orienting the diagnosis toward specific forms, and provide useful tools for risk stratification. The purpose of this review is to emphasize the important role of the ECG in the diagnostic workup, describing the main ECG findings of different cardiomyopathies.

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“…This ECG pattern was termed Goldberger's triad and was reported to have a 70% sensitivity and a 99% specificity for detecting severe LV dysfunction in idiopathic DCM 6 . However, later analyses failed to reproduce the reported high sensitivity of this ECG pattern, especially among patients with less severe ventricular dysfunction in DCM 7 . In patients with left bundle branch block, more prominent QRS voltages in the precordial leads, especially in lead V3, have been reported to be predictive of non‐ischaemic DCM 8 .…”

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confidence: 99%

A new perspective of an old tool: an everlasting benefit of the electrocardiogram in dilated cardiomyopathy

Seferović

Polovina

2020

European J of Heart Fail

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Goldberger's Electrocardiographic Triad in Patients With Echocardiographic Severe Left Ventricular Dysfunction

Cited by 12 publications

References 14 publications

Validation of electrocardiographic criteria for identifying left ventricular dysfunction in patients with previous myocardial infarction

Validation of electrocardiographic criteria for identifying left ventricular dysfunction in patients with previous myocardial infarction

The pivotal role of ECG in cardiomyopathies

A new perspective of an old tool: an everlasting benefit of the electrocardiogram in dilated cardiomyopathy

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