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A simple formula to predict echocardiographic diastolic dysfunction—electrocardiographic diastolic index

Eine einfache Formel zur Vorhersage der echokardiographischen diastolischen Dysfunktion – elektrokardiographischer diastolischer Index

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Abstract

Background

Diastolic dysfunction (DD) in transthoracic echocardiography (TTE), which is a poorly understood entity due to its limited treatment, is frequently encountered in daily clinical practice of cardiology. An electrocardiographic (ECG) index to predict echocardiographic DD has not been elucidated yet. We aim to exhibit an electrocardiographic diastolic index (EDI) to predict TTE DD with high sensitivity and specificity.

Materials and methods

In this retrospective investigation, we tested the DD predictive value of EDI [aVL R amplitude × (V1S amplitude + V5R amplitude)/D1 P amplitude] on 204 consecutive adult patients without known coronary artery disease. Patients were divided into tertiles according to their EDI starting from the lowest one. The power of the EDI was also compared with the subunits of its formula by a receiver operating curve (ROC) analysis.

Results

After adjustment for confounding baseline variables, EDI in tertile 3 was associated with 24.2-fold hazard ratio of DD (odds ratio 25.2, 95% confidence interval [CI] 11.2–51.1, p < 0.001). The Spearman correlation analysis revealed moderate correlation between E/e′ and EDI. A ROC analysis showed that the optimal cut-off value of the EDI to predict DD was 8.53 mV with 70% sensitivity and 70% specificity (area under the curve 0.78; 95% CI 0.71–0.84; p < 0.001).

Conclusion

The electrocardiographic diastolic index (EDI), which is an inexpensive, feasible, and easy to use formula, appears to have a considerable role to predict diastolic dysfunction (DD) in adult patients.

Zusammenfassung

Hintergrund

Die diastolische Dysfunktion (DD) in der transthorakalen Echokardiographie (TTE), die aufgrund ihrer begrenzten Behandlungsmöglichkeiten nur unzureichend verstanden wird, ist in der täglichen klinischen Praxis der Kardiologie häufig anzutreffen. Ein elektrokardiographischer (EKG) Index zur Vorhersage der echokardiographischen DD ist bisher noch nicht geklärt. Ziel dieses Beitrags ist es, einen elektrokardiographischen diastolischen Index (EDI) zur Vorhersage der TTE DD mit hoher Sensitivität und Spezifität aufzuzeigen.

Materialien und Methoden

In dieser retrospektiven Untersuchung wurde der DD-Prädiktionswert von EDI [aVL R‑Amplitude × (V1S-Amplitude + V5R-Amplitude)/D1 P‑Amplitude] an 204 konsekutiven erwachsenen Patienten ohne bekannte koronare Herzkrankheit getestet. Die Patienten wurden entsprechend ihrem EDI in Terzile eingeteilt, beginnend mit dem niedrigsten. Die Leistung des EDI wurde auch mit den Untereinheiten von dessen Formel durch eine Analyse der Receiver-operating-characteristic(ROC)-Kurve verglichen.

Ergebnisse

Nach Bereinigung konfundierender Baseline-Variablen war der EDI im 3. Terzil mit der 24,2-fachen Hazard-Ratio von DD assoziiert (Odds-Ratio: 25,2, 95 % Konfidenzintervall [KI] 11,2–51,1; p < 0,001). Die Spearman-Korrelationsanalyse ergab eine moderate Korrelation zwischen E/e′ und EDI. Eine ROC-Analyse zeigte, dass der optimale Cut-off-Wert des EDI zur Vorhersage der DD bei 8,53 mV mit 70 % Sensitivität und 70 % Spezifität lag („area under the curve“: 0,78; 95 % KI 0,71–0,84; p < 0,001).

Schlussfolgerung

Der elektrokardiographische diastolische Index (EDI), der eine kostengünstige, praktikable und einfach anzuwendende Formel darstellt, scheint eine beträchtliche Rolle bei der Vorhersage der diastolischen Dysfunktion (DD) bei erwachsenen Patienten zu spielen.

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Authors and Affiliations

  1. Department of Cardiology, Haydarpasa Sultan Abdulhamid Han Training and Research Hospital, 34668, Kadikoy-Istanbul, Turkey

    Mert İlker Hayıroğlu MD, Tufan Çınar, Vedat Çiçek, Süha Asal, Şahhan Kılıç, Nurgül Keser, Mehmet Uzun & Ahmet Lütfullah Orhan

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  1. Mert İlker Hayıroğlu MD
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  2. Tufan Çınar
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  3. Vedat Çiçek
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Correspondence to Mert İlker Hayıroğlu MD.

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Conflict of interest

M.İ. Hayıroğlu, T. Çınar, V. Çiçek, S. Asal, Ş. Kılıç, N. Keser, M. Uzun and A.L. Orhan declare that they have no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors.

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Hayıroğlu, M.İ., Çınar, T., Çiçek, V. et al. A simple formula to predict echocardiographic diastolic dysfunction—electrocardiographic diastolic index. Herz 46 (Suppl 2), 159–165 (2021). https://doi.org/10.1007/s00059-020-04972-6

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  • DOI: https://doi.org/10.1007/s00059-020-04972-6

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