© 2006 European Society of Cardiology
Prevalence of ECG abnormalities in an international survey of patients with suspected or confirmed heart failure at death or discharge
a University of Hull Kingston upon Hull, United Kingdom
b University of Birmingham Edgbaston United Kingdom
c Department of Medicine Sahlgrenska University Hospital Göteborg Sweden
d CHU Pitié-Salpetrière Paris, France
e Cardiology Research Complex A L Myasnikov Institute of Clinical Cardiology ul. Tretiya Cherepkovskaya Moscow, Russia
f Department of Internal Medicine, University Hospital Zurich, Switzerland
* Corresponding author. Department of Academic Cardiology, University of Hull, Castle Hill Hospital, Castle Road, Kingston upon Hull HU16 5JQ, UK. Tel.: +44 1482 624084; fax: +44 1482 624085. E-mail address: j.g.cleland{at}hull.ac.uk
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Abstract |
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Background: Most patients suspected of having heart failure (HF) will get a 12-lead electrocardiogram (ECG) but its utility for excluding HF or assisting in its management has rarely been investigated.
Methods: The EuroHeart Failure survey identified 11,327 patients hospitalised with a suspected diagnosis of HF from 115 hospitals in 24 countries. ECGs were obtained from 9315 patients, of whom 5934 had cardiac imaging tests. The utility of the ECG was assessed for excluding or diagnosing major structural heart disease (MSHD) or major left ventricular systolic dysfunction (MLVSD) and for therapeutic decision making.
Findings: MSHD was present in 70% and MLVSD in 54% of patients overall but in only 21% and 5%, respectively, if the ECG was entirely normal. However, <2% of patients had a normal ECG. No single ECG characteristic identified a probability <25% of MSHD or <20% of MLVSD. Patients with QRS width 
120 ms or anterior pathological Q-waves had a probability >80% of MSHD and >70% of MLVSD. Diagnostic models suggested that electrocardiographic criteria alone were not accurate for the diagnosis or exclusion of important heart disease in this population. However, 2468 patients (42%) had an electrocardiographic finding that should be used to guide the choice of therapy.
Conclusions: A normal ECG is rare in patients with suspected HF but has limited diagnostic value in this setting. The ECG has an important role in guiding therapy.
Key Words: ECG • Heart failure • Prevalence • Diagnosis
Received June 5, 2006; Revised October 5, 2006; Accepted November 13, 2006
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