Electrocardiogram as a screening tool to exclude chronic systolic heart failure with reduced left ventricular ejection fraction.

Abstract

Introduction: In recent years, the waiting time for outpatient echocardiography has been increasing. This has potential consequences for patients with de novo systolic heart failure (HF). Thus, screening methods for HF are needed. One method may be electrocardiogram (ECG). We assessed the diagnostic value of the ECG in identifying HF with reduced left ventricle ejection fraction (LVEF) in patients referred from primary care.

Methods: A 2020-2021 observational retrospective study was conducted on patients referred from primary care on suspicion of HF. All patients had ECG performed before LVEF was documented by echocardiography.

Results: In total, 248 patients (61.5%) presented with an abnormal ECG. Among these patients, 4.8% had LVEF 41-49% and 7.7% had LVEF ≤ 40%. An abnormal ECG was found to be associated with reduced LVEF. The negative predictive value of the ECG was 99%, regardless of whether the ECG was interpreted by the cardiologist or automatically. Adding the ECG to a logistic model with traditional risk factors, the ECG increased the area under curve from 0.72 to 0.79.

Conclusion: This study is the first study to assess the value of automatic ECG interpretation compared with a cardiologist's interpretation. The normal ECG can safely exclude HF with LVEF less-than 50% and may serve as a gatekeeping tool to further assist the primary care physician in identifying patients with de novo systolic HF.

Funding: None.

Trial registration: Not relevant.