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.
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 approximately 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.
  
  
  CONCLUSIONS
  Resting 12-lead A-ECG scoring is more accurate than strictly conventional ECG in screening for CAD, LVH and LVSD.
authors.affiliation: Human Adaptation and Countermeasures Division, NASA Johnson Space Center, Houston, TX, USA. todd.t.schlegel@nasa.gov
authors.forename: Todd T
authors.initials: TT
authors.lastname: Schlegel
authors.forename: Walter B
authors.initials: WB
authors.lastname: Kulecz
authors.forename: Alan H
authors.initials: AH
authors.lastname: Feiveson
authors.forename: E Carl
authors.initials: EC
authors.lastname: Greco
authors.forename: Jude L
authors.initials: JL
authors.lastname: DePalma
authors.forename: Vito
authors.initials: V
authors.lastname: Starc
authors.forename: Bojan
authors.initials: B
authors.lastname: Vrtovec
authors.forename: M Atiar
authors.initials: MA
authors.lastname: Rahman
authors.forename: Michael W
authors.initials: MW
authors.lastname: Bungo
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Hayat
authors.forename: Terry
authors.initials: T
authors.lastname: Bauch
authors.forename: Reynolds
authors.initials: R
authors.lastname: Delgado
authors.forename: Stafford G
authors.initials: SG
authors.lastname: Warren
authors.forename: Tulio
authors.initials: T
authors.lastname: Núñez-Medina
authors.forename: Rubén
authors.initials: R
authors.lastname: Medina
authors.forename: Diego
authors.initials: D
authors.lastname: Jugo
authors.forename: Håkan
authors.initials: H
authors.lastname: Arheden
authors.forename: Olle
authors.initials: O
authors.lastname: Pahlm
mesh_terms: D000328:Adult; D000368:Aged; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000503:physiopathology; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012107:Research Design; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000503:physiopathology