Open Access Highly Accessed Research article

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

Todd T Schlegel1*, Walter B Kulecz1, Alan H Feiveson1, E Carl Greco2, Jude L DePalma3, Vito Starc4, Bojan Vrtovec4, M Atiar Rahman5, Michael W Bungo5, Matthew J Hayat6, Terry Bauch7, Reynolds Delgado8, Stafford G Warren9, Tulio Núñez-Medina10, Rubén Medina11, Diego Jugo11, Håkan Arheden12 and Olle Pahlm12

Author Affiliations

1 Human Adaptation and Countermeasures Division, NASA Johnson Space Center, Houston, TX, USA

2 Department of Electrical Engineering, Arkansas Tech University, Russellville, AR, USA

3 Department of Engineering, Colorado State University, Pueblo, CO, USA

4 Institute of Physiology, School of Medicine, University of Ljubljana, Ljubljana, Slovenia

5 Division of Cardiovascular Medicine, University of Texas Health Science Center, Houston, TX, USA

6 Biostatistics, School of Nursing, Johns Hopkins University, Baltimore, MD, USA

7 Division of Cardiology, University of Texas Health Science Center, San Antonio, TX, USA

8 Heart and Lung Treatment and Transplant Center, Texas Heart Institute, Houston, TX, USA

9 Cardiac Catheterization Laboratory, Thomas Memorial Hospital, Charleston, WV, USA

10 Instituto de Investigaciones Cardiovasculares, Universidad de los Andes, Mérida, Venezuela

11 Grupo de Ingenieria Biomedica, Universidad de Los Andes, Mérida, Venezuela

12 Department of Clinical Physiology, Lund University Hospital, Lund, Sweden

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BMC Cardiovascular Disorders 2010, 10:28  doi:10.1186/1471-2261-10-28

Published: 16 June 2010



Resting conventional 12-lead ECG has low sensitivity for detection of coronary artery disease (CAD) and left ventricular hypertrophy (LVH) and low positive predictive value (PPV) for prediction of left ventricular systolic dysfunction (LVSD). We hypothesized that a ~5-min resting 12-lead advanced ECG test ("A-ECG") that combined results from both the advanced and conventional ECG could more accurately screen for these conditions than strictly conventional ECG.


Results from nearly every conventional and advanced resting ECG parameter known from the literature to have diagnostic or predictive value were first retrospectively evaluated in 418 healthy controls and 290 patients with imaging-proven CAD, LVH and/or LVSD. Each ECG parameter was examined for potential inclusion within multi-parameter A-ECG scores derived from multivariate regression models that were designed to optimally screen for disease in general or LVSD in particular. The performance of the best retrospectively-validated A-ECG scores was then compared against that of optimized pooled criteria from the strictly conventional ECG in a test set of 315 additional individuals.


Compared to optimized pooled criteria from the strictly conventional ECG, a 7-parameter A-ECG score validated in the training set increased the sensitivity of resting ECG for identifying disease in the test set from 78% (72-84%) to 92% (88-96%) (P < 0.0001) while also increasing specificity from 85% (77-91%) to 94% (88-98%) (P < 0.05). In diseased patients, another 5-parameter A-ECG score increased the PPV of ECG for LVSD from 53% (41-65%) to 92% (78-98%) (P < 0.0001) without compromising related negative predictive value.


Resting 12-lead A-ECG scoring is more accurate than strictly conventional ECG in screening for CAD, LVH and LVSD.