title: Justification of an introductory electrocardiogram teaching mnemonic by demonstration of its prognostic value.
abstract: OBJECTIVE
  With diminishing time afforded to electrocardiography in the medical curriculum, we have found Sibbitt's simple mnemonic, the Diagonal Line Lead Rule, for a pattern recognition approach to 12-lead electrocardiogram (ECG) interpretation to be appreciated by students. However, it still lacks universal acceptance because its clinical utility has not been documented. The study objective was to demonstrate the clinical utility of the Diagonal Line Lead ECG Teaching Rule.
  
  
  METHODS
  After excluding ECGs of high-risk patients with Wolff-Parkinson-White syndrome and QRS durations greater than 120 ms, the initial ECGs of the remaining 43,798 patients were scored according to the Diagonal Line Lead Rule. A total of 45,497 patients from the Veterans Affairs Palo Alto Healthcare System were referred for a routine initial resting ECG from 1987 to 1999. We determined cardiovascular mortality with 8 years of follow-up.
  
  
  RESULTS
  In patients with normal QRS duration, diagnostic Q-wave or T-wave inversions isolated to the diagonal line leads showed no increased risk of cardiovascular death. Q-wave or T-wave inversion in any other lead was significantly associated with cardiovascular death with an age-adjusted Cox hazard of 2.6 (confidence interval, 2.4-2.8; P < .0001) and an annual cardiovascular mortality rate of 3.0%. Leads V4-V6, I, and aVL were especially significant predictors of cardiovascular death, with a Cox hazard greater than 3.
  
  
  CONCLUSIONS
  Our analysis demonstrates the prognostic power and clinical utility of a simple mnemonic for 12-lead ECG interpretation that can facilitate ECG teaching and interpretation.
authors: Ohio State University College of Medicine, Columbus.
authors: Muhammad
authors: M
authors: Soofi
authors: Stanford Cardiovascular Institute/The Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, Calif.
authors: Celina
authors: C
authors: Yong
authors: Stanford Cardiovascular Institute/The Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, Calif; Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif. Electronic address: vicmdatg@gmail.com.
authors: Victor
authors: V
authors: Froelicher
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000401:mortality; D015331:Cohort Studies; D004501:Education, Medical / Q000379:methods*; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010364:Pattern Recognition, Visual; D011379:Prognosis; D012189:Retrospective Studies
keywords: Cardiovascular disease; Medical education-assessment/evaluation; Medical education-outcomes research