Electrical surrogate for detection of severe left ventricular systolic dysfunction

Background Early diagnosis and therapy improves outcomes in heart failure with severely reduced left ventricular ejection fraction ( LVEF ≤35%), but some patients may remain undiagnosed. We hypothesized that a combination of electrocardiogram ( ECG ) markers may identify individuals with severely reduced LVEF . Methods From a community‐based study in the Northwest US (the Oregon Sudden Unexpected Death Study), we evaluated the prevalence of conventional ECG markers by LVEF . We then evaluated the association of nine additional ECG markers and LVEF . We validated the correlation of these ECG markers and LVEF in a separate, large health system in Los Angeles, California. Results In the discovery population ( n  = 1,047), patients with LVEF ≤35% were twice as likely as those with LVEF >35% to have ≥1 conventional ECG abnormality. In the subset without conventional ECG abnormalities, ≥4 abnormal ECG markers from the expanded panel were found in 12% vs. 1% of patients with LVEF ≤35% and >35%, respectively. In the validation population ( n  = 9,742), 44% with LVEF ≤35% and 17% with LVEF >35% had ≥1 conventional ECG abnormality. In patients without conventional ECG abnormalities ( n  = 7,601), 40% with LVEF ≤35% and 5% with LVEF >35% had ≥4 abnormal ECG markers from the expanded panel. Each additional abnormal ECG marker from the expanded panel (range 0 to ≥4) more than doubled the odds of LVEF ≤35%. Conclusions An expanded panel of easily obtained ECG markers correlated strongly with severely reduced LVEF in two separate populations. This electrical surrogate score could facilitate diagnosis of severely reduced LVEF , and warrants prospective evaluation.