A novel electrocardiographic index for the diagnosis of diastolic dysfunction.
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.


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.
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.
Mehdi
M
Namdar
Patric
P
Biaggi
Barbara
B
Stähli
Bernhard
B
Bütler
Rubén
R
Casado-Arroyo
Danilo
D
Ricciardi
Moisés
M
Rodríguez-Mañero
Jan
J
Steffel
David
D
Hürlimann
Christian
C
Schmied
Carlo
C
de Asmundis
Gian-Battista
GB
Chierchia
Andrea
A
Sarkozy
Thomas F
TF
Lüscher
Rolf
R
Jenni
Firat
F
Duru
Walter J
WJ
Paulus
Pedro
P
Brugada
D000328:Adult; D000368:Aged; D003971:Diastole; D015150:Echocardiography, Doppler / Q000379:methods; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology*