Prevalence of ECG abnormalities in an international survey of patients with suspected or confirmed heart failure at death or discharge.
BACKGROUND
Most patients suspected of having heart failure (HF) will get a 12-lead electrocardiogram (ECG) but its utility for excluding HF or assisting in its management has rarely been investigated.


METHODS
The EuroHeart Failure survey identified 11,327 patients hospitalised with a suspected diagnosis of HF from 115 hospitals in 24 countries. ECGs were obtained from 9315 patients, of whom 5934 had cardiac imaging tests. The utility of the ECG was assessed for excluding or diagnosing major structural heart disease (MSHD) or major left ventricular systolic dysfunction (MLVSD) and for therapeutic decision making.


RESULTS
MSHD was present in 70% and MLVSD in 54% of patients overall but in only 21% and 5%, respectively, if the ECG was entirely normal. However, <2% of patients had a normal ECG. No single ECG characteristic identified a probability <25% of MSHD or <20% of MLVSD. Patients with QRS width >or=120 ms or anterior pathological Q-waves had a probability >80% of MSHD and >70% of MLVSD. Diagnostic models suggested that electrocardiographic criteria alone were not accurate for the diagnosis or exclusion of important heart disease in this population. However, 2468 patients (42%) had an electrocardiographic finding that should be used to guide the choice of therapy.


CONCLUSIONS
A normal ECG is rare in patients with suspected HF but has limited diagnostic value in this setting. The ECG has an important role in guiding therapy.
Khan
Nasrin K
NK
University of Hull, Kingston upon Hull, United Kingdom.
Goode
Kevin M
KM
Cleland
John G F
JG
Rigby
Alan S
AS
Freemantle
Nick
N
Eastaugh
Joanne
J
Clark
Andrew L
AL
de Silva
Ramesh
R
Calvert
Melanie J
MJ
Swedberg
Karl
K
Komajda
Michael
M
Mareev
Viu
V
Follath
Ferenc
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003625:Data Collection; D004562:Electrocardiography; D005060:Europe / Q000453:epidemiology; D005260:Female; D006329:Heart Conduction System / Q000002:abnormalities / Q000503:physiopathology; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D006333:Heart Failure / Q000175:diagnosis* / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D006339:Heart Rate; D006801:Humans; D016013:Likelihood Functions; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D015995:Prevalence; D012107:Research Design; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology