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A novel electrocardiographic index for the diagnosis of diastolic dysfunction.

Namdar M, Biaggi P, Stähli B, Bütler B, Casado-Arroyo R, Ricciardi D, Rodríguez-Mañero M, Steffel J, Hürlimann D, Schmied C, de Asmundis C, Chierchia GB, Sarkozy A, Lüscher TF, Jenni R, Duru F, Paulus WJ, Brugada P - PLoS ONE (2013)

Bottom Line: Our aim was to investigate a potential role of ECG indices for the recognition of patients with DD.The patient group with a DD Grade 1 and 2 showed longer QTc (422 ± 24 ms and 434 ± 32 ms vs. 409 ± 25ms, p<0.0005) and shorter Tend-P and Tend-Q intervals, reflecting the electrical and mechanical diastole (240 ± 78 ms and 276 ± 108 ms vs. 373 ± 110 ms, p<0.0001; 409 ± 85 ms and 447 ± 115 ms vs. 526 ± 119 ms, p<0.0001).The PQ-interval was significantly longer in the patient group (169 ± 28ms and 171 ± 38ms vs. 153 ± 22ms, p<0.005).

View Article: PubMed Central - PubMed

Affiliation: Heart Rhythm Management Centre, Cardiovascular Division, UZ Brussel - VUB, Brussels, Belgium ; Cardiovascular Centre, Cardiology, University Hospital of Zurich, Zurich, Switzerland ; Service de Cardiologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland.

ABSTRACT

Background: Although the assessment of diastolic dysfunction (DD) is an integral part of routine cardiologic examinations, little is known about associated electrocardiographic (ECG) changes. Our aim was to investigate a potential role of ECG indices for the recognition of patients with DD.

Methods and results: ECG parameters correlating with echocardiographic findings of DD were retrospectively assessed in a derivation group of 172 individuals (83 controls with normal diastolic function, 89 patients with DD) and their diagnostic performance was tested in a validation group of 50 controls and 50 patients. The patient group with a DD Grade 1 and 2 showed longer QTc (422 ± 24 ms and 434 ± 32 ms vs. 409 ± 25ms, p<0.0005) and shorter Tend-P and Tend-Q intervals, reflecting the electrical and mechanical diastole (240 ± 78 ms and 276 ± 108 ms vs. 373 ± 110 ms, p<0.0001; 409 ± 85 ms and 447 ± 115 ms vs. 526 ± 119 ms, p<0.0001). The PQ-interval was significantly longer in the patient group (169 ± 28ms and 171 ± 38ms vs. 153 ± 22ms, p<0.005). After adjusting for possible confounders, a novel index (Tend-P/[PQxAge]) showed a high performance for the recognition of DD, stayed robust in the validation group (sensitivity 82%, specificity 93%, positive predictive value 93%, negative predictive value 82%, accuracy 88%) and proved a substantial added value when combined with the indexed left atrial volume (LAESVI, sensitivity 90%, specificity 92%, positive predictive value 95%, negative predictive value 86%, accuracy 91%).

Conclusions: A novel electrocardiographic index Tend-P/(PQxAge) demonstrates a high diagnostic accuracy for the diagnosis of DD and yields a substantial added value when combined with the LAESVI.

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Related in: MedlinePlus

Schematic illustration of Tend-P and Tend-Q measurements.ECG-intervals of interest (Tend-P, Tend-Q) reflecting the mechanical diastole were both manually measured and calculated as: RR minus PQ minus QT for Tend-P and RR minus QT for Tend-Q.
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pone-0079152-g001: Schematic illustration of Tend-P and Tend-Q measurements.ECG-intervals of interest (Tend-P, Tend-Q) reflecting the mechanical diastole were both manually measured and calculated as: RR minus PQ minus QT for Tend-P and RR minus QT for Tend-Q.

Mentions: Twelve-lead surface ECG at initial diagnosis were independently analyzed by two experienced readers. Measurements were taken manually from the tracings at 25mm/sec. The observers were blinded to the echocardiographic findings, and the ECG reading has been performed by consensus reading. Standard criteria for ECG findings were applied: The QTc interval was calculated using the Bazett formula [10]. The QT/QTc dispersion was defined as the difference between the maximum and minimum QT/QTc interval of the 12 leads [11,12]. The Tpeak-Tend was measured in each precordial lead measured from the peak of the T-wave until the end of T-wave. In the case of negative or biphasic T waves, Tpeak was measured from the nadir of the T-wave. In accordance with the Lewis or Wiggers cycle, ECG-intervals of interest (Tend-P, Tend-Q, Figure 1) reflecting the mechanical diastole were also included in our analysis [13]. These two intervals were both manually measured (taking into account all ECG leads) and calculated as: RR minus PQ minus QT for Tend-P and RR minus QT for Tend-Q. Single leads with T waves smaller than 1.5 mm in amplitude were not included in the analysis. Patients were excluded if they had atrial fibrillation, higher than grade I AV-block, atrial and/or ventricular pacing and history as well as signs of acute ischemia and/or cardiopulmonary decompensation.


A novel electrocardiographic index for the diagnosis of diastolic dysfunction.

Namdar M, Biaggi P, Stähli B, Bütler B, Casado-Arroyo R, Ricciardi D, Rodríguez-Mañero M, Steffel J, Hürlimann D, Schmied C, de Asmundis C, Chierchia GB, Sarkozy A, Lüscher TF, Jenni R, Duru F, Paulus WJ, Brugada P - PLoS ONE (2013)

Schematic illustration of Tend-P and Tend-Q measurements.ECG-intervals of interest (Tend-P, Tend-Q) reflecting the mechanical diastole were both manually measured and calculated as: RR minus PQ minus QT for Tend-P and RR minus QT for Tend-Q.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3818461&req=5

pone-0079152-g001: Schematic illustration of Tend-P and Tend-Q measurements.ECG-intervals of interest (Tend-P, Tend-Q) reflecting the mechanical diastole were both manually measured and calculated as: RR minus PQ minus QT for Tend-P and RR minus QT for Tend-Q.
Mentions: Twelve-lead surface ECG at initial diagnosis were independently analyzed by two experienced readers. Measurements were taken manually from the tracings at 25mm/sec. The observers were blinded to the echocardiographic findings, and the ECG reading has been performed by consensus reading. Standard criteria for ECG findings were applied: The QTc interval was calculated using the Bazett formula [10]. The QT/QTc dispersion was defined as the difference between the maximum and minimum QT/QTc interval of the 12 leads [11,12]. The Tpeak-Tend was measured in each precordial lead measured from the peak of the T-wave until the end of T-wave. In the case of negative or biphasic T waves, Tpeak was measured from the nadir of the T-wave. In accordance with the Lewis or Wiggers cycle, ECG-intervals of interest (Tend-P, Tend-Q, Figure 1) reflecting the mechanical diastole were also included in our analysis [13]. These two intervals were both manually measured (taking into account all ECG leads) and calculated as: RR minus PQ minus QT for Tend-P and RR minus QT for Tend-Q. Single leads with T waves smaller than 1.5 mm in amplitude were not included in the analysis. Patients were excluded if they had atrial fibrillation, higher than grade I AV-block, atrial and/or ventricular pacing and history as well as signs of acute ischemia and/or cardiopulmonary decompensation.

Bottom Line: Our aim was to investigate a potential role of ECG indices for the recognition of patients with DD.The patient group with a DD Grade 1 and 2 showed longer QTc (422 ± 24 ms and 434 ± 32 ms vs. 409 ± 25ms, p<0.0005) and shorter Tend-P and Tend-Q intervals, reflecting the electrical and mechanical diastole (240 ± 78 ms and 276 ± 108 ms vs. 373 ± 110 ms, p<0.0001; 409 ± 85 ms and 447 ± 115 ms vs. 526 ± 119 ms, p<0.0001).The PQ-interval was significantly longer in the patient group (169 ± 28ms and 171 ± 38ms vs. 153 ± 22ms, p<0.005).

View Article: PubMed Central - PubMed

Affiliation: Heart Rhythm Management Centre, Cardiovascular Division, UZ Brussel - VUB, Brussels, Belgium ; Cardiovascular Centre, Cardiology, University Hospital of Zurich, Zurich, Switzerland ; Service de Cardiologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland.

ABSTRACT

Background: Although the assessment of diastolic dysfunction (DD) is an integral part of routine cardiologic examinations, little is known about associated electrocardiographic (ECG) changes. Our aim was to investigate a potential role of ECG indices for the recognition of patients with DD.

Methods and results: ECG parameters correlating with echocardiographic findings of DD were retrospectively assessed in a derivation group of 172 individuals (83 controls with normal diastolic function, 89 patients with DD) and their diagnostic performance was tested in a validation group of 50 controls and 50 patients. The patient group with a DD Grade 1 and 2 showed longer QTc (422 ± 24 ms and 434 ± 32 ms vs. 409 ± 25ms, p<0.0005) and shorter Tend-P and Tend-Q intervals, reflecting the electrical and mechanical diastole (240 ± 78 ms and 276 ± 108 ms vs. 373 ± 110 ms, p<0.0001; 409 ± 85 ms and 447 ± 115 ms vs. 526 ± 119 ms, p<0.0001). The PQ-interval was significantly longer in the patient group (169 ± 28ms and 171 ± 38ms vs. 153 ± 22ms, p<0.005). After adjusting for possible confounders, a novel index (Tend-P/[PQxAge]) showed a high performance for the recognition of DD, stayed robust in the validation group (sensitivity 82%, specificity 93%, positive predictive value 93%, negative predictive value 82%, accuracy 88%) and proved a substantial added value when combined with the indexed left atrial volume (LAESVI, sensitivity 90%, specificity 92%, positive predictive value 95%, negative predictive value 86%, accuracy 91%).

Conclusions: A novel electrocardiographic index Tend-P/(PQxAge) demonstrates a high diagnostic accuracy for the diagnosis of DD and yields a substantial added value when combined with the LAESVI.

Show MeSH
Related in: MedlinePlus