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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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Patient flow chart.
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pone-0079152-g002: Patient flow chart.

Mentions: A total of 254 individuals were initially included. After application of the above-mentioned exclusion criteria, 172 (83 normal controls, 67 patients with DD grade 1, 14 patients with DD grade 2 and 8 patients with DD grade 3) remained for the analysis. However, all eight patients showing a restrictive left ventricular filling pattern (DD grade 3) had to be excluded from the study due to severe wall motion abnormalities along with severe left ventricular systolic dysfunction (Figure 2).


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)

Patient flow chart.
© Copyright Policy
Related In: Results  -  Collection

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

pone-0079152-g002: Patient flow chart.
Mentions: A total of 254 individuals were initially included. After application of the above-mentioned exclusion criteria, 172 (83 normal controls, 67 patients with DD grade 1, 14 patients with DD grade 2 and 8 patients with DD grade 3) remained for the analysis. However, all eight patients showing a restrictive left ventricular filling pattern (DD grade 3) had to be excluded from the study due to severe wall motion abnormalities along with severe left ventricular systolic dysfunction (Figure 2).

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