Accuracy of advanced versus strictly conventional 12-lead ECG for detection and screening of coronary artery disease, left ventricular hypertrophy and left ventricular systolic dysfunction

<p>Abstract</p> <p>Background</p> <p>Resting conventional 12-lead ECG has low sensitivity for detection of coronary artery disease (CAD) and left ventricular hypertrophy (LVH) and low positive predictive value (PPV) for prediction of left ventricular systolic dysfunctio...

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Main Authors: Warren Stafford G, Delgado Reynolds, Bauch Terry, Hayat Matthew J, Bungo Michael W, Rahman M, Vrtovec Bojan, Starc Vito, DePalma Jude L, Greco E, Feiveson Alan H, Kulecz Walter B, Schlegel Todd T, Núñez-Medina Tulio, Medina Rubén, Jugo Diego, Arheden Håkan, Pahlm Olle
Format: Article
Language:English
Published: BMC 2010-06-01
Series:BMC Cardiovascular Disorders
Online Access:http://www.biomedcentral.com/1471-2261/10/28
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spelling doaj-6415d110dc7640fcb8326fe35cbc2f852020-11-25T01:59:20ZengBMCBMC Cardiovascular Disorders1471-22612010-06-011012810.1186/1471-2261-10-28Accuracy of advanced versus strictly conventional 12-lead ECG for detection and screening of coronary artery disease, left ventricular hypertrophy and left ventricular systolic dysfunctionWarren Stafford GDelgado ReynoldsBauch TerryHayat Matthew JBungo Michael WRahman MVrtovec BojanStarc VitoDePalma Jude LGreco EFeiveson Alan HKulecz Walter BSchlegel Todd TNúñez-Medina TulioMedina RubénJugo DiegoArheden HåkanPahlm Olle<p>Abstract</p> <p>Background</p> <p>Resting conventional 12-lead ECG has low sensitivity for detection of coronary artery disease (CAD) and left ventricular hypertrophy (LVH) and low positive predictive value (PPV) for prediction of left ventricular systolic dysfunction (LVSD). We hypothesized that a ~5-min resting 12-lead <it>advanced </it>ECG test ("A-ECG") that combined results from both the advanced and conventional ECG could more accurately screen for these conditions than strictly conventional ECG.</p> <p>Methods</p> <p>Results from nearly every conventional and advanced resting ECG parameter known from the literature to have diagnostic or predictive value were first retrospectively evaluated in 418 healthy controls and 290 patients with imaging-proven CAD, LVH and/or LVSD. Each ECG parameter was examined for potential inclusion within multi-parameter A-ECG scores derived from multivariate regression models that were designed to optimally screen for disease in general or LVSD in particular. The performance of the best retrospectively-validated A-ECG scores was then compared against that of optimized pooled criteria from the strictly conventional ECG in a test set of 315 additional individuals.</p> <p>Results</p> <p>Compared to optimized pooled criteria from the strictly conventional ECG, a 7-parameter A-ECG score validated in the training set increased the sensitivity of resting ECG for identifying disease in the test set from 78% (72-84%) to 92% (88-96%) (P < 0.0001) while also increasing specificity from 85% (77-91%) to 94% (88-98%) (P < 0.05). In diseased patients, another 5-parameter A-ECG score increased the PPV of ECG for LVSD from 53% (41-65%) to 92% (78-98%) (P < 0.0001) without compromising related negative predictive value.</p> <p>Conclusion</p> <p>Resting 12-lead A-ECG scoring is more accurate than strictly conventional ECG in screening for CAD, LVH and LVSD.</p> http://www.biomedcentral.com/1471-2261/10/28
collection DOAJ
language English
format Article
sources DOAJ
author Warren Stafford G
Delgado Reynolds
Bauch Terry
Hayat Matthew J
Bungo Michael W
Rahman M
Vrtovec Bojan
Starc Vito
DePalma Jude L
Greco E
Feiveson Alan H
Kulecz Walter B
Schlegel Todd T
Núñez-Medina Tulio
Medina Rubén
Jugo Diego
Arheden Håkan
Pahlm Olle
spellingShingle Warren Stafford G
Delgado Reynolds
Bauch Terry
Hayat Matthew J
Bungo Michael W
Rahman M
Vrtovec Bojan
Starc Vito
DePalma Jude L
Greco E
Feiveson Alan H
Kulecz Walter B
Schlegel Todd T
Núñez-Medina Tulio
Medina Rubén
Jugo Diego
Arheden Håkan
Pahlm Olle
Accuracy of advanced versus strictly conventional 12-lead ECG for detection and screening of coronary artery disease, left ventricular hypertrophy and left ventricular systolic dysfunction
BMC Cardiovascular Disorders
author_facet Warren Stafford G
Delgado Reynolds
Bauch Terry
Hayat Matthew J
Bungo Michael W
Rahman M
Vrtovec Bojan
Starc Vito
DePalma Jude L
Greco E
Feiveson Alan H
Kulecz Walter B
Schlegel Todd T
Núñez-Medina Tulio
Medina Rubén
Jugo Diego
Arheden Håkan
Pahlm Olle
author_sort Warren Stafford G
title Accuracy of advanced versus strictly conventional 12-lead ECG for detection and screening of coronary artery disease, left ventricular hypertrophy and left ventricular systolic dysfunction
title_short Accuracy of advanced versus strictly conventional 12-lead ECG for detection and screening of coronary artery disease, left ventricular hypertrophy and left ventricular systolic dysfunction
title_full Accuracy of advanced versus strictly conventional 12-lead ECG for detection and screening of coronary artery disease, left ventricular hypertrophy and left ventricular systolic dysfunction
title_fullStr Accuracy of advanced versus strictly conventional 12-lead ECG for detection and screening of coronary artery disease, left ventricular hypertrophy and left ventricular systolic dysfunction
title_full_unstemmed Accuracy of advanced versus strictly conventional 12-lead ECG for detection and screening of coronary artery disease, left ventricular hypertrophy and left ventricular systolic dysfunction
title_sort accuracy of advanced versus strictly conventional 12-lead ecg for detection and screening of coronary artery disease, left ventricular hypertrophy and left ventricular systolic dysfunction
publisher BMC
series BMC Cardiovascular Disorders
issn 1471-2261
publishDate 2010-06-01
description <p>Abstract</p> <p>Background</p> <p>Resting conventional 12-lead ECG has low sensitivity for detection of coronary artery disease (CAD) and left ventricular hypertrophy (LVH) and low positive predictive value (PPV) for prediction of left ventricular systolic dysfunction (LVSD). We hypothesized that a ~5-min resting 12-lead <it>advanced </it>ECG test ("A-ECG") that combined results from both the advanced and conventional ECG could more accurately screen for these conditions than strictly conventional ECG.</p> <p>Methods</p> <p>Results from nearly every conventional and advanced resting ECG parameter known from the literature to have diagnostic or predictive value were first retrospectively evaluated in 418 healthy controls and 290 patients with imaging-proven CAD, LVH and/or LVSD. Each ECG parameter was examined for potential inclusion within multi-parameter A-ECG scores derived from multivariate regression models that were designed to optimally screen for disease in general or LVSD in particular. The performance of the best retrospectively-validated A-ECG scores was then compared against that of optimized pooled criteria from the strictly conventional ECG in a test set of 315 additional individuals.</p> <p>Results</p> <p>Compared to optimized pooled criteria from the strictly conventional ECG, a 7-parameter A-ECG score validated in the training set increased the sensitivity of resting ECG for identifying disease in the test set from 78% (72-84%) to 92% (88-96%) (P < 0.0001) while also increasing specificity from 85% (77-91%) to 94% (88-98%) (P < 0.05). In diseased patients, another 5-parameter A-ECG score increased the PPV of ECG for LVSD from 53% (41-65%) to 92% (78-98%) (P < 0.0001) without compromising related negative predictive value.</p> <p>Conclusion</p> <p>Resting 12-lead A-ECG scoring is more accurate than strictly conventional ECG in screening for CAD, LVH and LVSD.</p>
url http://www.biomedcentral.com/1471-2261/10/28
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