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Open Access 01-12-2010 | Research article

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

Authors: Todd T Schlegel, Walter B Kulecz, Alan H Feiveson, E Carl Greco, Jude L DePalma, Vito Starc, Bojan Vrtovec, M Atiar Rahman, Michael W Bungo, Matthew J Hayat, Terry Bauch, Reynolds Delgado, Stafford G Warren, Tulio Núñez-Medina, Rubén Medina, Diego Jugo, Håkan Arheden, Olle Pahlm

Published in: BMC Cardiovascular Disorders | Issue 1/2010

Abstract

Background

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 advanced 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.

Methods

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.

Results

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.

Conclusion

Resting 12-lead A-ECG scoring is more accurate than strictly conventional ECG in screening for CAD, LVH and LVSD.

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The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2261/10/28/prepub

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
Authors: Todd T Schlegel
Walter B Kulecz
Alan H Feiveson
E Carl Greco
Jude L DePalma
Vito Starc
Bojan Vrtovec
M Atiar Rahman
Michael W Bungo
Matthew J Hayat
Terry Bauch
Reynolds Delgado
Stafford G Warren
Tulio Núñez-Medina
Rubén Medina
Diego Jugo
Håkan Arheden
Olle Pahlm
Publication date: 01-12-2010
Publisher: BioMed Central
Published in: BMC Cardiovascular Disorders / Issue 1/2010
Electronic ISSN: 1471-2261
DOI: https://doi.org/10.1186/1471-2261-10-28

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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

Abstract

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