Journal of electrocardiology最新文献

{"title":"Predictive value of standard electrocardiographic parameters for major adverse cardiovascular events in patients with coronary heart disease: A retrospective cohort study","authors":"Man Yang ,&nbsp;Huan Zhao ,&nbsp;Yajuan Yin ,&nbsp;Xuekun Li ,&nbsp;Yinge Zhan","doi":"10.1016/j.jelectrocard.2026.154200","DOIUrl":"10.1016/j.jelectrocard.2026.154200","url":null,"abstract":"<div><h3>Background</h3><div>Accurate risk stratification is crucial for managing patients with coronary heart disease (CHD). This study aimed to investigate the value of baseline electrocardiogram (ECG) indicators in predicting one-year major adverse cardiovascular events (MACE) in patients with CHD.</div></div><div><h3>Methods</h3><div>This single-center, retrospective cohort study enrolled 200 hospitalized patients with a confirmed CHD diagnosis. Baseline demographic, clinical, echocardiographic, and 12-lead ECG data were collected. The primary endpoint was the occurrence of MACE (a composite of cardiac death, non-fatal acute MI, severe arrhythmia, severe heart failure, and stroke) within one year. Univariate and multivariable logistic regression analyses were performed to identify independent ECG predictors, with predictive performance evaluated using receiver operating characteristic (ROC) curve analysis.</div></div><div><h3>Results</h3><div>During a one-year follow-up, 29 of 200 patients (14.5%) experienced a MACE. Patients with MACE had significantly worse baseline cardiac function, including lower left ventricular ejection fraction (LVEF) and higher E/e' ratio. In multivariable analysis, higher resting heart rate (OR per 10 bpm: 1.54, 95% CI: 1.09-2.17, P=0.014), longer QRS duration (OR per 10 ms: 1.69, 95% CI: 1.16-2.47, P=0.006), and longer corrected QT (QTc) interval (OR per 10 ms: 1.63, 95% CI: 1.23-2.15, P&lt;0.001) were independent predictors of MACE. A combined model integrating these three parameters demonstrated excellent predictive accuracy (AUC=0.85, 95% CI: 0.78-0.92), superior to any single parameter. The QTc interval was the best single predictor (AUC=0.79).</div></div><div><h3>Conclusion</h3><div>Higher resting heart rate, longer QRS duration, and longer QTc interval are independent and powerful predictors of one-year MACE in patients with CHD. A combined model using these simple ECG markers provides robust risk stratification, offering significant incremental predictive value over baseline clinical factors.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"95 ","pages":"Article 154200"},"PeriodicalIF":1.2,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146180540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electrocardiographic repolarization changes following conduction system pacing in pacemaker-induced cardiomyopathy","authors":"Ahmet Taha Sahin ,&nbsp;Ugur Canpolat ,&nbsp;Muhammet Dural ,&nbsp;Mert Dogan ,&nbsp;Gurbet Ozge Yunus ,&nbsp;Istiklal Ozkaya ,&nbsp;Serhat Kesriklioglu ,&nbsp;Meltem Uyaner Kan ,&nbsp;Ahmet Lutfu Sertdemir ,&nbsp;Enes Elvin Gul MD","doi":"10.1016/j.jelectrocard.2026.154197","DOIUrl":"10.1016/j.jelectrocard.2026.154197","url":null,"abstract":"<div><h3>Background</h3><div>Pacemaker-induced cardiomyopathy (PICM) occurs in a subset of patients exposed to chronic right ventricular pacing (RVP) and results in left ventricular dysfunction due to pacing-related dyssynchrony. Left bundle branch area pacing (LBBAP) has emerged as a physiologic pacing strategy capable of restoring conduction system activation and reversing PICM. However, the acute effects of LBBAP on ventricular repolarization in PICM remain unclear. This study evaluated immediate repolarization changes after LBBAP in PICM compared with a control cohort of non-ischemic dilated cardiomyopathy (DCM) patients undergoing LBBAP.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed clinical, electrocardiographic, and pacing data from patients receiving successful LBBAP. Baseline and post-implant ECG intervals (QT, QTc, Tp–Te) were manually measured; T-wave memory (TWM) was qualitatively assessed. Procedure parameters (RWPT, V6–V1 interpeak interval, output-dependent QRS transition), procedural success, and complications were recorded.</div></div><div><h3>Results</h3><div>Sixty patients were included (28 PICM vs. 32 DCM). Baseline LVEF was higher in patients with PICM compared to DCM (35 ± 8% vs. 29 ± 7%; <em>p</em> = 0.003). LBBAP success was similar (93% vs. 96%). PICM patients had wider paced QRS (149 ms vs. 128 ms; <em>p</em> = 0.02) and longer V6–V1 interval (46 ± 12 vs. 38 ± 10 ms; p = 0.02), but repolarization metrics showed no adverse changes and remained comparable between groups. QT shortened similarly (PICM: 476 → 437 ms; DCM: 466 → 432 ms), QTc minimally increased without group interaction, Tp–Te decreased, and TWM was frequent in both cohorts (63% vs. 64%). Complications rate was also comparable.</div></div><div><h3>Conclusion</h3><div>LBBAP does not induce unfavorable acute repolarization changes in PICM and yields repolarization responses comparable to DCM controls, supporting its safety and physiologic benefit in PICM upgrades.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"95 ","pages":"Article 154197"},"PeriodicalIF":1.2,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146073956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of repolarization abnormalities with 12-lead ECG and 24-hour Holter ECG monitoring in patients with Duchenne muscular dystrophy","authors":"Elif Didinmez Taşkırdı ,&nbsp;Aycan Ünalp ,&nbsp;Ünsal Yılmaz ,&nbsp;Timur Meşe ,&nbsp;Murat Muhtar Yılmazer","doi":"10.1016/j.jelectrocard.2026.154198","DOIUrl":"10.1016/j.jelectrocard.2026.154198","url":null,"abstract":"<div><h3>Background</h3><div>Duchenne muscular dystrophy (DMD) is an inherited neuromuscular disorder causing progressive degeneration of skeletal and cardiac muscles due to dystrophin deficiency. Cardiac involvement ranges from mild to severe, including heart failure, arrhythmias, conduction defects, and sudden cardiac death.</div></div><div><h3>Objective</h3><div>This study aimed to evaluate early markers of cardiac repolarization abnormalities in DMD patients by analyzing standard 12‑lead ECG parameters—QT interval, corrected QT (QTc), T peak to T end (Tp-e), Tp-e/QT, and Tp-e/QTc ratios—and microvolt T-wave alternans (MTWA) from 24-h Holter monitoring.</div></div><div><h3>Methods</h3><div>Seventy-four individuals participated: 39 DMD patients and 35 age- and sex-matched healthy controls. Data on demographics, ambulation status, ECG, and Holter recordings were collected and compared. All participants underwent standard 12‑lead electrocardiography and 24-h Holter electrocardiogram monitoring. ECG measurements were performed manually by a blinded operator using standardized techniques. Holter recordings were collected and compared (analyzable data obtained from 33 patients and 34 controls). The QTc interval was calculated using Bazett's formula. Correlation analyses and statistical comparisons between groups were performed using appropriate parametric and non-parametric tests.</div></div><div><h3>Results</h3><div>DMD patients exhibited significantly higher resting heart rates. The Tp-e interval was similar between groups, while the QT interval was significantly shorter in the patient group, the QTc interval showed no significant difference between groups. Tp-e/QT ratio was higher in the patient group; Tp-e/QTc ratios showed no difference. The QTc interval was significantly prolonged in the non-ambulatory DMD group. MTWA values did not differ significantly between groups. Due to the limited sample size and absence of established pediatric reference values, MTWA findings must be considered inconclusive.</div></div><div><h3>Conclusion</h3><div>In conclusion, our study reveals subtle repolarization alterations in DMD patients, including elevated resting heart rate and a trend toward increased Tp-e/QT ratio. While these findings do not yet establish a definitive arrhythmic phenotype, they suggest the presence of early electrophysiological changes that may warrant longitudinal cardiac evaluation. Prospective follow-up studies are essential to determine the prognostic significance of these parameters and their relationship to clinical arrhythmic outcomes in the pediatric DMD population.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"95 ","pages":"Article 154198"},"PeriodicalIF":1.2,"publicationDate":"2026-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146074047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing atrial fibrillation detection through ECG feature selection using Extra-Trees and statistical association measures","authors":"Georgios Petmezas ,&nbsp;Vasileios E. Papageorgiou ,&nbsp;Rod S. Passman ,&nbsp;John A. Rogers ,&nbsp;Leandros Stefanopoulos ,&nbsp;Aggelos K. Katsaggelos ,&nbsp;Nicos Maglaveras","doi":"10.1016/j.jelectrocard.2026.154199","DOIUrl":"10.1016/j.jelectrocard.2026.154199","url":null,"abstract":"<div><h3>Introduction</h3><div>Atrial fibrillation (AFib) is the most prevalent abnormal heart rhythm, significantly increasing the risk of stroke and heart failure. Accurate and timely detection remains challenging, particularly due to the complexity of 12‑lead electrocardiogram (ECG) interpretation. While machine learning (ML) and deep learning (DL) models have demonstrated high accuracy in AFib detection, selecting the optimal input features is often non-trivial. This study aims to develop a hybrid feature selection methodology that objectively identifies the most discriminative ECG-based features for distinguishing AFib from normal sinus rhythm (NSR).</div></div><div><h3>Material &amp; methods</h3><div>We propose a hybrid framework that combines Extremely Randomized Trees (Extra-Trees) with statistical association measures to identify physiologically meaningful ECG features. Our analysis evaluates morphological, entropy-based and spectral hand-crafted features extracted from 12‑lead ECG recordings of patients who underwent catheter ablation for AFib. Two novel metrics, the feature importance score (FIS) and overall feature importance score (OFIS), are introduced to quantify feature relevance.</div></div><div><h3>Results</h3><div>The proposed approach ranked 97 extracted features and identified the 10 most important per ECG lead and 20 most relevant overall, with high consistency across leads. The interquartile range of RR-intervals achieved the highest normalized OFIS value (0.064), followed by other rhythm-related and entropy-based measures, confirming their strong discriminative power. The dimensionality of the feature space was thus reduced by nearly 80% while preserving interpretability and physiological meaning.</div></div><div><h3>Conclusions</h3><div>This methodology provides a reproducible, interpretable and statistically grounded framework for ECG-based feature discovery, offering a preprocessing step for ML/DL models and aiding clinicians in real-time AFib detection.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"95 ","pages":"Article 154199"},"PeriodicalIF":1.2,"publicationDate":"2026-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146074049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The value of ST-segment deviation in lead aVR for predicting the infarct-related artery in acute inferior STEMI: A systematic review and meta-analysis","authors":"Yang-Yu Li ,&nbsp;Fang Zeng ,&nbsp;Ju Deng,&nbsp;Bin Huang,&nbsp;Guang-Dong Yan,&nbsp;Xi-Wei Chen,&nbsp;Biao Li,&nbsp;Yao-Gui Chen,&nbsp;Hui Yang,&nbsp;Qiang Zhao,&nbsp;Li Li","doi":"10.1016/j.jelectrocard.2026.154196","DOIUrl":"10.1016/j.jelectrocard.2026.154196","url":null,"abstract":"<div><h3>Background</h3><div>The infarct-related artery (IRA) in acute inferior wall ST-segment elevation myocardial infarction (inferior STEMI) is predominantly the left circumflex artery (LCX) or the right coronary artery (RCA). Electrocardiographic ST-segment deviation in lead aVR has shown potential value in predicting the IRA, but systematic evidence is lacking.</div></div><div><h3>Methods</h3><div>A comprehensive literature search was undertaken across Web of Science, PubMed, and Scopus to identify relevant studies published until March 2025. Pooled sensitivity and specificity were calculated using a bivariate effects model. Overall accuracy was quantified by the diagnostic odds ratio (DOR) and area under the curve (AUC).</div></div><div><h3>Results</h3><div>Twenty-four studies (6416 participants) were included. For LCX prediction, aVR ST-segment depression (aVR-STD) demonstrated pooled sensitivity of 0.62 (95% CI: 0.51–0.72), specificity of 0.81 (95% CI: 0.75–0.86), and good overall accuracy [DOR = 7.01 (95% CI: 3.72–13.22), AUC = 0.80 (95% CI: 0.76–0.83)]. Conversely, aVR ST-segment elevation (aVR-STE) was a poor predictor for LCX [sensitivity = 0.02 (95% CI: 0.01–0.08), AUC = 0.55 (95% CI: 0.51–0.59)]. For RCA prediction, aVR-STE demonstrated pooled sensitivity of 0.06 (95% CI: 0.03–0.13), specificity of 0.97 (95% CI: 0.93–0.98), and moderate overall accuracy [DOR = 1.99 (95% CI: 1.15–3.43), AUC = 0.75 (95% CI: 0.71–0.79)]. aVR-STD was a poor predictor for RCA [sensitivity = 0.19 (95% CI: 0.13–0.27), AUC = 0.23 (95% CI: 0.19–0.27)]. Heterogeneity analysis identified the ST-segment reference point and smoking history as potential contributors.</div></div><div><h3>Conclusion</h3><div>In inferior STEMI, aVR-STD demonstrates significant value in predicting LCX as the IRA, while its accuracy appears moderated by the ST-segment measurement reference point and smoking history. Conversely, aVR-STE shows limited predictive value for RCA.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"95 ","pages":"Article 154196"},"PeriodicalIF":1.2,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146034299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Malignant arrhythmia risk assessment based on lead-I mobile ECG measurements using machine learning","authors":"Gergely Tuboly ,&nbsp;Orsolya Kiss ,&nbsp;Máté Babity ,&nbsp;Márk Zámodics ,&nbsp;Béla Merkely ,&nbsp;György Kozmann ,&nbsp;Mohamed F. Issa","doi":"10.1016/j.jelectrocard.2026.154194","DOIUrl":"10.1016/j.jelectrocard.2026.154194","url":null,"abstract":"<div><div>This paper presents an algorithm capable of estimating malignant arrhythmia risk based on a short lead-I ECG record. We chose the mean and relative standard deviation of beat-to-beat QRST integrals as feature parameters. The algorithm was trained on a learning set consisting of three subgroups: 55 healthy subjects, 48 patients without malignant arrhythmia history, and 48 malignant arrhythmia patients. These subgroups represented the normal, moderate, and high risk, respectively. The 3 nearest neighbors (3−NN), and the 1-D and 2-D Bayesian classifiers were used as supervised machine-learning techniques. The test set contained ECG signals of 63 healthy subjects and 52 patients with confirmed malignant arrhythmia records. We obtained the best classification results with the 2-D Bayesian classifier, which produced a decision efficiency of 87.30% and 94.23% for the normal and malignant arrhythmia cases, respectively. Slightly lower results were achieved by the 3-NN method (80.95%, 94.23%) and the 1-D Bayesian classifier (77.78%, 94.23%). Considering the QTc parameter instead of the QRST integral produced a relatively low decision efficiency in the malignant arrhythmia case (84.62%). The proposed method performs best with the 2-D Bayesian method, while it is still efficient with the 3-NN classifier. According to our current knowledge, our algorithm is the first one which only requires a single-channel ECG as input and efficiently estimates malignant arrhythmia risk at the same time. As the proposed method relies only on lead-I ECG, it can be very useful in mobile ECG systems (e.g., in WIWE), making out-of-hospital risk assessment possible.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"95 ","pages":"Article 154194"},"PeriodicalIF":1.2,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146029642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond STEMI criteria: The electrocardiographic “South African Flag Sign” revealing an isolated proximal ramus intermedius occlusion","authors":"Lucio Giuseppe Granata MD ,&nbsp;Alfredo Busà MD ,&nbsp;Marcello Marchetta MD ,&nbsp;Giulia Alagna MD ,&nbsp;Francesco Amico MD","doi":"10.1016/j.jelectrocard.2026.154195","DOIUrl":"10.1016/j.jelectrocard.2026.154195","url":null,"abstract":"<div><div>The South African Flag Sign (SAFS) is an emerging ECG marker of acute coronary occlusion and a potential STEMI-equivalent, though not yet included in guidelines. It features ST elevation in I-aVL and V2 with reciprocal depression in III (and often in additional inferior leads) usually associated with first diagonal branch (D1) occlusion. We report a 66-year-old man with chest pain and SAFS, found to have an isolated sub-occlusive proximal ramus intermedius lesion successfully treated with primary PCI. This case shows that SAFS reflects an occlusion myocardial infarction and serves as a marker of the ischaemic territory rather than a specific culprit vessel, being generated by arteries other than D1 when they share a similar course and perfusion territory. Greater awareness may prevent misclassification and expedite reperfusion therapy.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"95 ","pages":"Article 154195"},"PeriodicalIF":1.2,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145979128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Innovative application of six-lead KardiaMobile device in children under three years of age","authors":"Jakub Zabłocki ,&nbsp;Magdalena Warych ,&nbsp;Julia Krawczyk ,&nbsp;Jan Herc ,&nbsp;Piotr Wieniawski ,&nbsp;Bożena Werner","doi":"10.1016/j.jelectrocard.2026.154193","DOIUrl":"10.1016/j.jelectrocard.2026.154193","url":null,"abstract":"<div><div>The use of the six‑lead AliveCor KardiaMobile (6LACKM) has not been thoroughly evaluated in children under three years of age. This report presents our initial experience with modified 6LACKM ECG acquisition techniques tailored to this population, including hand-assisted chest placement and adhesive electrodes adaptation, in various patient states and positions. In a prospective study, we aim to assess the feasibility of 6LACKM in this population and compare its diagnostic quality to standard 12‑lead ECG. Our preliminary experience demonstrate that high-quality tracings can be obtained with the proposed approaches, supporting the potential utility of 6LACKM in early pediatric electrocardiographic monitoring.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"95 ","pages":"Article 154193"},"PeriodicalIF":1.2,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145940570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exercise high-frequency QRS versus exercise stress electrocardiography in diagnosing myocardial ischemia: A meta-analysis","authors":"Zhewen Wang ,&nbsp;Siteng Wang ,&nbsp;Ming Liu ,&nbsp;Dan Li ,&nbsp;Jinsheng Hua ,&nbsp;Xiangyong Kong ,&nbsp;Hongwu Chen ,&nbsp;Hao Hu ,&nbsp;Chao Gao ,&nbsp;Jianyuan Pan","doi":"10.1016/j.jelectrocard.2026.154190","DOIUrl":"10.1016/j.jelectrocard.2026.154190","url":null,"abstract":"<div><h3>Background and objects</h3><div>Exercise stress high-frequency QRS (ES-HFQRS) is a new non-invasive diagnostic technique mainly for myocardial ischemia, which has been demonstrated with favorable diagnostic efficacy in patients with early ischemic symptoms. Multiple studies confirmed ES-HFQRS's superior diagnostic performance over traditional exercise stress electrocardiography (EST) analysis. However, until now, there is still no meta-analysis that compares the diagnostic efficacy of ES-HFQRS and EST.Therefore, this meta aims to compare the diagnostic value of ES-HFQRS with EST.</div></div><div><h3>Methods</h3><div>Databases were searched up to August 4, 2025, using keywords including “exercise stress HFQRS” and “exercise stress electrocardiography”. Sensitivity and specificity were pooled using a bivariate random-effects model. Summary receiver operating characteristic (SROC) curves were plotted, and the area under the curve (AUC) was calculated. Subgroup analyses and Meta-regression explored sources of heterogeneity.</div></div><div><h3>Results</h3><div>Ten studies involving 3352 patients were included. The pooled sensitivity of ES-HFQRS was significantly higher than that of EST (65% [95% CI: 55%–73%] vs. 37% [95% CI: 29%–45%]; <em>P</em> &lt; 0.001), with no significant difference in specificity (78% [95% CI: 72%–83%] for HFQRS vs. 85% [95% CI: 78%–90%] for EST; <em>P</em> = 0.12). The AUCs of ES-HFQRS and EST were 0.77 and 0.64, respectively. Parallel test combining both methods achieved significantly higher sensitivity than EST alone (76% [95% CI: 69%–82%] vs. 37% [95% CI: 29%–45%]; <em>P</em> &lt; 0.001) while maintaining stable specificity at 64% (95% CI: 58%–70%). The serial test increased specificity to 96% (95% CI: 94%–97%),with a significantly lower sensitivity of 22% (95% CI: 17%–29%).</div></div><div><h3>Conclusion</h3><div>ES-HFQRS had superior sensitivity to EST for the non-invasive diagnosis of myocardial ischemia. Combining both analytical methods flexibly could enhance the diagnostic value in the detection of myocardial ischemia.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"95 ","pages":"Article 154190"},"PeriodicalIF":1.2,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146018745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cumulative electrocardiogram abnormalities predict left ventricular ejection fraction reduction: EchoNext database analysis","authors":"Solomon Kim MPH ,&nbsp;Beshoy Saad BA ,&nbsp;Gary Chu MD","doi":"10.1016/j.jelectrocard.2026.154192","DOIUrl":"10.1016/j.jelectrocard.2026.154192","url":null,"abstract":"<div><h3>Background</h3><div>Individual electrocardiographic abnormalities associate with reduced left ventricular ejection fraction (LVEF), but whether multiple continuous ECG parameters provide synergistic predictive value compared to single parameters or binary scoring remains incompletely characterized.</div></div><div><h3>Methods</h3><div>QRS duration, PR interval, and heart rate-corrected QT interval (QTc) from ECGs were analyzed in 89,630 paired ECG-echocardiogram studies from the EchoNext database. After systematic evaluation of missing data patterns revealing significant selection bias, the cohort was divided into training (70%, <em>n</em> = 62,741) and validation (30%, <em>n</em> = 26,889) sets using stratified sampling. Seven logistic regression models were developed, all adjusted for age and sex. Models were evaluated using bootstrap confidence intervals with 1000 iterations and 5-fold stratified cross-validation.</div></div><div><h3>Results</h3><div>The full continuous model achieved fair discrimination (AUC 0.710, 95% CI 0.699–0.714) compared to QTc alone (AUC 0.695, ΔAUC = 0.016, <em>p</em> &lt; 0.001). Among individual parameters, QTc demonstrated strongest association (AUC 0.695), followed by QRS duration (AUC 0.673) and PR interval (AUC 0.603). LVEF ≤45% prevalence increased from 15.9% (0 abnormalities) to 30.6% (1 abnormality), 49.5% (2 abnormalities), and 58.3% (3 abnormalities) (Cochran-Armitage Z = 76.0, <em>p</em> &lt; 0.001). At the optimal threshold, the model achieved sensitivity 59.9%, specificity 72.6%, positive predictive value 37.9%, and negative predictive value 86.7%. All models showed excellent calibration slopes (range 0.963–1.043). Cross-validation confirmed stability (CV AUC 0.706 ± 0.006).</div></div><div><h3>Conclusions</h3><div>Combined continuous ECG parameters provide predictive value for reduced LVEF compared to individual parameters or binary classifications. However, selection bias from non-random missing data (42.0% vs 21.8% outcome prevalence in incomplete vs complete cases, <em>p</em> &lt; 0.001) suggests findings likely underestimate true associations.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"95 ","pages":"Article 154192"},"PeriodicalIF":1.2,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145940568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}