A Novel Electrocardiographic Index for the Diagnosis of Diastolic Dysfunction

Abstract

BackgroundAlthough 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.Methods and ResultsECG 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±24ms and 434±32ms vs. 409±25ms, p<0.0005) and shorter Tend–P and Tend–Q intervals, reflecting the electrical and mechanical diastole (240±78ms and 276±108ms vs. 373±110ms, p<0.0001; 409±85ms and 447±115ms vs. 526±119ms, 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%).ConclusionsA 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.

How accurate can electrocardiogram predict left ventricular diastolic dysfunction?

“…Our results agree with previous studies done by Gunduz et al, Namdar et al, and Dae-Hyeok et al 9,18,22 This significant correlation between p wave dispersion and diastolic dysfunction can be explained by the fact that left ventricular diastolic dysfunction in a hypertrophic or ischemic ventricle results in an increase in left ventricular end-diastolic (LVED) pressure and in left atrial dimensions. The increase in left atrial dimensions as a result of rising intra-atrial pressure changes the geometry of atrial fibrils; this, in combination with nonhomogeneous fibrosis of the left atrial wall, interrupts the conduction of sinus impulses.…”

“…Regarding only corrected QT interval, our results match the results of a study by Wilcox et al and Namdar et al 8,18 Two other studies revealed a significant correlation between diastolic dysfunction and corrected QT interval. 19 A previous study including patients with hypertension and LV hypertrophy also found a modest correlation between the traditional Doppler parameters of diastolic dysfunction (E/A ratio and isovolumic relaxation time) and QTc.…”

“…19 A previous study including patients with hypertension and LV hypertrophy also found a modest correlation between the traditional Doppler parameters of diastolic dysfunction (E/A ratio and isovolumic relaxation time) and QTc. 18 In our study we also concluded that there is no significant correlation between TpTe interval in resting ECG and diastolic dysfunction (p = 0.726). These results did not agree with the results of study of Sauer et al, but agreed with the results of Namdar et al 5,18 Multiple recent studies have demonstrated the role of Twave analysis, and TpTe in particular, as a potential ECG biomarker of dispersion of repolarization.…”

“…18 In our study we also concluded that there is no significant correlation between TpTe interval in resting ECG and diastolic dysfunction (p = 0.726). These results did not agree with the results of study of Sauer et al, but agreed with the results of Namdar et al 5,18 Multiple recent studies have demonstrated the role of Twave analysis, and TpTe in particular, as a potential ECG biomarker of dispersion of repolarization. In addition, some experiments have begun to investigate the ability of pharmacologically reversing dispersion of repolarization measured by TpTe as a potential therapeutic mechanism for reducing proarrhythmic substrate.…”

“…9 On the other hand, our results disagreed with the results of Namdar et al, regarding the relation between age and diastolic dysfunction but agreed with his results regarding the relation between sex and diastolic dysfunction. 18 Our study revealed that there was a nonsignificant difference in TpTe (p = 0.648) while there was a significant difference between both groups regarding QT interval (p = 0.005) and a strong significant difference between them regarding the QTc and P wave dispersion (p < 0.0005).…”