{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T23:08:28Z","timestamp":1773270508191,"version":"3.50.1"},"reference-count":31,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2015,5,13]],"date-time":"2015-05-13T00:00:00Z","timestamp":1431475200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>Electrocardiogram (ECG)-based detection of left ventricular systolic dysfunction (LVSD) has poor specificity and positive predictive value, even when including major ECG abnormalities, such as left bundle branch block (LBBB) within the criteria for diagnosis. Although machine-read ECG algorithms do not provide information on LVSD, advanced ECG (A-ECG), using multiparameter scores, has superior diagnostic utility to strictly conventional ECG for identifying various cardiac pathologies, including LVSD. Methods: We evaluated the diagnostic utility of A-ECG in a case-control study of 40 patients with LVSD (LV ejection fraction &lt; 50% by echocardiography), due to  non-ischemic cardiomyopathy (NICM), and 39 other patients without LVSD. Diagnostic sensitivity and specificity for LVSD were determined after applying a previously validated probabilistic A-ECG score for LVSD to stored standard (10 s) clinical 12L ECGs. In 25 of the NICM patients who had serial ECGs and echocardiograms, changes in the A-ECG score versus in echocardiographic LV ejection fraction were also studied to determine the level of agreement between the two tests. Results: Analyses by A-ECG had a sensitivity of 95% for LVSD (93% if excluding N = 11 patients with LBBB) and specificity of 95%. In the 29 NICM patients without LBBB who had serial ECGs, sensitivity improved to 97% when all ECGs were considered. By comparison, human readers in a busy clinical environment had a sensitivity of 90% and specificity of 63%. A-ECG score trajectories demonstrated improvement, deterioration or no change in LVSD, which agreed with echocardiography, in 76% of cases (n = 25). Conclusion: A-ECG scoring detects LVSD due to NICM with high sensitivity and specificity. Serial A-ECG score trajectories also represent a method for inexpensively demonstrating changes in LVSD. A-ECG scoring may be of particular value in areas where echocardiography is unavailable, or as a gatekeeper for echocardiography.<\/jats:p>","DOI":"10.3390\/jcdd2020093","type":"journal-article","created":{"date-parts":[[2015,5,13]],"date-time":"2015-05-13T12:42:07Z","timestamp":1431520927000},"page":"93-107","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Advanced Electrocardiography Identifies Left Ventricular Systolic Dysfunction in Non-Ischemic Cardiomyopathy and Tracks Serial Change over Time"],"prefix":"10.3390","volume":"2","author":[{"given":"Kerryanne","family":"Johnson","sequence":"first","affiliation":[{"name":"North Shore hospital, Waitemata District Health Board, Takapuna, 0620 Auckland, New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stacey","family":"Neilson","sequence":"additional","affiliation":[{"name":"North Shore hospital, Waitemata District Health Board, Takapuna, 0620 Auckland, New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"To","sequence":"additional","affiliation":[{"name":"North Shore hospital, Waitemata District Health Board, Takapuna, 0620 Auckland, New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nezar","family":"Amir","sequence":"additional","affiliation":[{"name":"North Shore hospital, Waitemata District Health Board, Takapuna, 0620 Auckland, New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Cave","sequence":"additional","affiliation":[{"name":"North Shore hospital, Waitemata District Health Board, Takapuna, 0620 Auckland, New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tony","family":"Scott","sequence":"additional","affiliation":[{"name":"North Shore hospital, Waitemata District Health Board, Takapuna, 0620 Auckland, New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Orr","sequence":"additional","affiliation":[{"name":"North Shore hospital, Waitemata District Health Board, Takapuna, 0620 Auckland, New Zealand"},{"name":"Clinical Informatics Systems Group, North Shore Hospital, Waitemata District Health Board, Takapuna, 0620 Auckland, New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mia","family":"Parata","sequence":"additional","affiliation":[{"name":"North Shore hospital, Waitemata District Health Board, Takapuna, 0620 Auckland, New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victoria","family":"Day","sequence":"additional","affiliation":[{"name":"North Shore hospital, Waitemata District Health Board, Takapuna, 0620 Auckland, New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick","family":"Gladding","sequence":"additional","affiliation":[{"name":"North Shore hospital, Waitemata District Health Board, Takapuna, 0620 Auckland, New Zealand"},{"name":"Theranostics Laboratory, North Shore Hospital, Waitemata District Health Board, Takapuna,  0620 Auckland, New Zealand"},{"name":"Auckland Bioengineering Institute, University of Auckland, 0620 Auckland, New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2015,5,13]]},"reference":[{"key":"ref_1","first-page":"191","article-title":"Screening for left ventricular systolic dysfunction using GP-reported ECGs","volume":"57","author":"Goudie","year":"2007","journal-title":"Br. J. Gen. Pract."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1357","DOI":"10.1016\/S0195-668X(03)00203-3","article-title":"Spatial QRS-T angle predicts cardiac death in a general population","volume":"24","author":"Kardys","year":"2003","journal-title":"Eur. Heart J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1016\/j.ijcard.2006.09.025","article-title":"Improvement of the detection of myocardial ischemia thanks to information technologies","volume":"120","author":"Fayn","year":"2007","journal-title":"Int. J. cardiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1161\/CIRCULATIONAHA.105.537415","article-title":"Electrocardiographic predictors of incident congestive heart failure and all-cause mortality in postmenopausal women, the Women\u2019s Health Initiative","volume":"113","author":"Rautaharju","year":"2006","journal-title":"Circulation"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.hrthm.2004.10.040","article-title":"Spatial QRS-T angle predicts cardiac death in a clinical population","volume":"2","author":"Yamazaki","year":"2005","journal-title":"Heart rhythm"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"945","DOI":"10.1111\/j.1540-8167.2005.40808.x","article-title":"Repolarization abnormality for prediction of all-cause and cardiovascular mortality in American Indians: the Strong Heart Study","volume":"16","author":"Okin","year":"2005","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1066","DOI":"10.1161\/hc0902.104598","article-title":"Analysis of T-wave morphology from the 12-lead electrocardiogram for prediction of long-term prognosis in male US veterans","volume":"105","author":"Zabel","year":"2002","journal-title":"Circulation"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1016\/j.jelectrocard.2005.11.004","article-title":"The effect of signal averaging on the reproducibility and reliability of measures of T-wave morphology","volume":"39","author":"Batdorf","year":"2006","journal-title":"J. Electrocardiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"339","DOI":"10.4065\/79.3.339","article-title":"Real-time 12-lead high-frequency QRS electrocardiography for enhanced detection of myocardial ischemia and coronary artery disease","volume":"79","author":"Schlegel","year":"2004","journal-title":"Mayo. Clin. Proc."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1557","DOI":"10.1161\/01.CIR.96.5.1557","article-title":"Beat-to-beat QT interval variability: Novel evidence for repolarization lability in ischemic and nonischemic dilated cardiomyopathy","volume":"96","author":"Berger","year":"1997","journal-title":"Circulation"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1344","DOI":"10.1093\/eurheartj\/ehl367","article-title":"QT variability strongly predicts sudden cardiac death in asymptomatic subjects with mild or moderate left ventricular systolic dysfunction: A prospective study","volume":"28","author":"Piccirillo","year":"2007","journal-title":"Eur. Heart. J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"S178","DOI":"10.1111\/j.1540-8159.2005.00076.x","article-title":"Coronary artery disease alters ventricular repolarization dynamics in type 2 diabetes","volume":"28","author":"Vrtovec","year":"2005","journal-title":"Pacing. Clin. Electrophysiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1016\/j.jelectrocard.2006.03.004","article-title":"Real-time multichannel system for beat-to-beat QT interval variability","volume":"39","author":"Starc","year":"2006","journal-title":"J. Electrocardiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1093\/oxfordjournals.eurheartj.a014868","article-title":"Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology","volume":"17","author":"Marek","year":"1996","journal-title":"Eur. Heart J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2466","DOI":"10.1073\/pnas.012579499","article-title":"Fractal dynamics in physiology: Alterations with disease and aging","volume":"99","author":"Goldberger","year":"2002","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1109\/34.824819","article-title":"Statistical pattern recognition: A review","volume":"22","author":"Jain","year":"2000","journal-title":"IEEE Trans. Pattern Anal. Mach. Intell."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Schlegel, T.T., Kulecz, W.B., Feiveson, A.H., Greco, E.C., DePalma, J.L., Starc, V., Vrtovec, B., Rahman, M.A., Bungo, M.W., and Hayat, M.J. (2010). Accuracy of advanced versus strictly conventional 12-lead ECG for detection and screening of coronary artery disease, left ventricular hypertrophy and left ventricular systolic dysfunction. BMC Cardiovasc. Disord., 10.","DOI":"10.1186\/1471-2261-10-28"},{"key":"ref_18","unstructured":"Committee, N.E.A. Streamlined ethical guidelines for health and disability research, http:\/\/neac.health.govt.nz\/streamlined-ethical-guidelines-health-and-disability-research."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.1093\/oxfordjournals.eurheartj.a059647","article-title":"Reconstruction of the Frank vectorcardiogram from standard electrocardiographic leads: diagnostic comparison of different methods","volume":"11","author":"Kors","year":"1990","journal-title":"Eur. Heart J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"203","DOI":"10.3390\/jpm3030203","article-title":"Open Access Integrated Therapeutic and Diagnostic Platforms for Personalized Cardiovascular Medicine","volume":"3","author":"Gladding","year":"2013","journal-title":"J. Pers. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1056\/NEJM198201073060102","article-title":"A QRS scoring system for assessing left ventricular function after myocardial infarction","volume":"306","author":"Palmeri","year":"1982","journal-title":"N. Engl. J. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/0002-9149(78)90125-X","article-title":"Computerized orthogonal electrocardiogram: relation of QRS forces to left ventricular ejection fraction","volume":"41","author":"Gottwik","year":"1978","journal-title":"Am. J. Cardiol."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Davie, A.P., Francis, C.M., Love, M.P., Caruana, L., Starkey, I.R., Shaw, T.R., Sutherland, G.R., and McMurray, J.J. (1996). Value of the electrocardiogram in identifying heart failure due to left ventricular systolic dysfunction. BMJ, 312.","DOI":"10.1136\/bmj.312.7025.222"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1136\/hrt.2005.061200","article-title":"Relation between severity of left ventricular systolic dysfunction and repolarisation abnormalities on the surface ECG: A report from the Euro heart failure survey","volume":"92","author":"Velavan","year":"2006","journal-title":"Heart"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1136\/hrt.53.3.248","article-title":"Limitations of a QRS scoring system to assess left ventricular function and prognosis at hospital discharge after myocardial infarction","volume":"53","author":"Fioretti","year":"1985","journal-title":"Br. Heart J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1479","DOI":"10.1016\/S0735-1097(83)80052-7","article-title":"Limitations of electrocardiographic scoring systems for estimation of left ventricular function","volume":"1","author":"Young","year":"1983","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1016\/j.jelectrocard.2009.06.007","article-title":"Electrocardiography-left ventricular mass discrepancies in left ventricular hypertrophy: Electrocardiography imperfection or beyond perfection?","volume":"42","author":"Bacharova","year":"2009","journal-title":"J. Electrocardiol."},{"key":"ref_28","first-page":"548","article-title":"Predicting Ventricular Arrhythmias in Patients With Ischemic Heart Disease: Clinical Application of the ECG-Derived QRS-T Angle","volume":"2","author":"Borleffs","year":"2009","journal-title":"Circulation"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1111\/j.1542-474X.2005.00627.x","article-title":"Response of the ECG to short-term diuresis in patients with heart failure","volume":"10","author":"Madias","year":"2005","journal-title":"Ann. Noninvasive Electrocardiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1786","DOI":"10.1161\/01.CIR.90.4.1786","article-title":"Prognostic implications of baseline electrocardiographic features and their serial changes in subjects with left ventricular hypertrophy","volume":"90","author":"Levy","year":"1994","journal-title":"Circulation"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1002\/clc.22171","article-title":"Diagnostic accuracy and cost-effectiveness of a pocket-sized transthoracic echocardiographic imaging device","volume":"36","author":"Kitada","year":"2013","journal-title":"Clin. Cardiol."}],"container-title":["Journal of Cardiovascular Development and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3425\/2\/2\/93\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T20:46:17Z","timestamp":1760215577000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3425\/2\/2\/93"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,5,13]]},"references-count":31,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2015,6]]}},"alternative-id":["jcdd2020093"],"URL":"https:\/\/doi.org\/10.3390\/jcdd2020093","relation":{},"ISSN":["2308-3425"],"issn-type":[{"value":"2308-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,5,13]]}}}