Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://www.cardiologyres.org

Original Article

Volume 7, Number 3, June 2016, pages 110-116

Scoring System Based on Electrocardiogram Features to Predict the Type of Heart Failure in Patients With Chronic Heart Failure

**Table 1.** Basic Subject Characteristics Based on Heart Failure Type
Variable	HFpEF (n = 50)	HFrEF (n = 60)	Total (n = 110)	P
HFpEF: heart failure preserved ejection fraction; HFrEF: heart failure reduced ejection fraction; DM: diabetes mellitus; ACE-I: angiotensin converting enzyme inhibitor; ARB: angiotensin receptor blocker; CCB: calcium channel blocker.
Age, years (± SD)	59.7 ± 9.2	57.9 ± 10.1	58.6 ± 9.9	0.29
Sex				0.003
Male, n (%)	28 (56)	49 (81.7)	77 (70)
Female, n (%)	22 (44)	11 (18.3)	33 (30)
Risk factor
Hypertension, n (%)	46 (92)	39 (65)	85 (77.2)	0.001
DM, n (%)	19 (38)	13 (21.7)	32 (29.1)	0.06
Smoker, n (%)	11 (22)	29 (48.3)	40 (36.3)	0.004
Therapy
ACE-I/ARB, n (%)	50 (100)	60 (100)	110 (100)	1.000
Diuretic, n (%)	37 (74)	57 (95)	94 (85.4)	0.002
Beta blocker, n (%)	21 (42)	30 (50)	51 (46.3)	0.042
CCB, n (%)	22 (44)	6 (10)	28 (25.4)	< 0.0001

Table 1. Basic Subject Characteristics Based on Heart Failure Type

Variable

HFpEF (n = 50)

HFrEF (n = 60)

Total (n = 110)

HFpEF: heart failure preserved ejection fraction; HFrEF: heart failure reduced ejection fraction; DM: diabetes mellitus; ACE-I: angiotensin converting enzyme inhibitor; ARB: angiotensin receptor blocker; CCB: calcium channel blocker.

Age, years (± SD)

59.7 ± 9.2

57.9 ± 10.1

58.6 ± 9.9

0.29

Sex

0.003

Male, n (%)

28 (56)

49 (81.7)

77 (70)

Female, n (%)

22 (44)

11 (18.3)

33 (30)

Risk factor

Hypertension, n (%)

46 (92)

39 (65)

85 (77.2)

0.001

DM, n (%)

19 (38)

13 (21.7)

32 (29.1)

0.06

Smoker, n (%)

11 (22)

29 (48.3)

40 (36.3)

0.004

Therapy

ACE-I/ARB, n (%)

50 (100)

60 (100)

110 (100)

1.000

Diuretic, n (%)

37 (74)

57 (95)

94 (85.4)

0.002

Beta blocker, n (%)

21 (42)

30 (50)

51 (46.3)

0.042

CCB, n (%)

22 (44)

6 (10)

28 (25.4)

< 0.0001

**Table 2.** Echocardiography Basic Characteristics Based on Heart Failure Type
Variables	HFpEF (n = 50)	HFrEF (n = 60)	P
LA: left atrium; LVIDd: left ventricular internal diameter end diastole; IVSd: Interventricular septal end diastole; EF: ejection fraction; LVMI: left ventricular mass index; LAVI: left atrial volume index; DT: deceleration time; TAPSE: tricuspid annular plane systolic excursion; RVSP: right ventricle systolic pressure.
LA diameter, mm (± SD)	34.3 ± 5.2	41.5 ± 6.2	< 0.0001
LVIDd, mm (± SD)	49.2 ± 7.1	64.9 ± 7.9	< 0.0001
IVSd, mm (± SD)	12.5 ± 2.1	10.3 ± 2.6	< 0.0001
EF Simpson, % (± SD)	59.2 ± 8.5	29.4 ± 6.8	< 0.0001
LVMI, g/m² (± SD)	133.3 ± 40.2	170.3 ± 46.7	< 0.0001
Septal e’	5.09 ± 1.1	4.3 ± 1.2	< 0.0001
Lateral e’	6.21 ± 1.6	5.6 ± 2.5	0.146
LAVI, mL/m² (± SD)	34.5 ± 4.3	47.1 ± 14.4	< 0.0001
E/A ratio	0.77 ± 0.2	1.8 ± 1.2	< 0.0001
DT, ms (± SD)	234 ± 53.3	158.4 ± 52.8	< 0.0001
Diastolic dysfunction			1.000
Relaxation, n	39	16
Pseudonormal, n	11	15
Restrictive, n	0	29
TAPSE, mm (± SD)	23.2 ± 3.1	18.1 ± 4.3	< 0.0001
RVSP, mm Hg (± SD)	6.64 ± 9.1	26.8 ± 22.6	< 0.0001
Myocard kinetic disturbance			< 0.0001
Yes	15	60
No	35	0
Heart rate, /min (± SD)	71.8 ± 12.8	81.7 ± 15	0.135

Table 2. Echocardiography Basic Characteristics Based on Heart Failure Type

Variables

HFpEF (n = 50)

HFrEF (n = 60)

LA: left atrium; LVIDd: left ventricular internal diameter end diastole; IVSd: Interventricular septal end diastole; EF: ejection fraction; LVMI: left ventricular mass index; LAVI: left atrial volume index; DT: deceleration time; TAPSE: tricuspid annular plane systolic excursion; RVSP: right ventricle systolic pressure.

LA diameter, mm (± SD)

34.3 ± 5.2

41.5 ± 6.2

< 0.0001

LVIDd, mm (± SD)

49.2 ± 7.1

64.9 ± 7.9

< 0.0001

IVSd, mm (± SD)

12.5 ± 2.1

10.3 ± 2.6

< 0.0001

EF Simpson, % (± SD)

59.2 ± 8.5

29.4 ± 6.8

< 0.0001

LVMI, g/m² (± SD)

133.3 ± 40.2

170.3 ± 46.7

< 0.0001

Septal e’

5.09 ± 1.1

4.3 ± 1.2

< 0.0001

Lateral e’

6.21 ± 1.6

5.6 ± 2.5

0.146

LAVI, mL/m² (± SD)

34.5 ± 4.3

47.1 ± 14.4

< 0.0001

E/A ratio

0.77 ± 0.2

1.8 ± 1.2

< 0.0001

DT, ms (± SD)

234 ± 53.3

158.4 ± 52.8

< 0.0001

Diastolic dysfunction

1.000

Relaxation, n

Pseudonormal, n

Restrictive, n

TAPSE, mm (± SD)

23.2 ± 3.1

18.1 ± 4.3

< 0.0001

RVSP, mm Hg (± SD)

6.64 ± 9.1

26.8 ± 22.6

< 0.0001

Myocard kinetic disturbance

< 0.0001

Yes

Heart rate, /min (± SD)

71.8 ± 12.8

81.7 ± 15

0.135

**Table 3.** ECG Basic Characteristics Based on Heart Failure Type
ECG parameter	HFpEF (n = 50)	HFrEF (n = 60)	Total (n = 110)	P
LAH: left atrial hypertrophy; LVH: left ventricular hypertrophy; LAD: left axis deviation; RAD: right axis deviation; LBBB: left bundle branch block; RBBB: right bundle branch block.
LAH, n (%)	6 (12)	22 (36.7)	28 (25.5)	0.003
LVH, n (%)	15 (30)	33 (55)	48 (43.6)	0.008
Poor R wave, n (%)	5 (10)	30 (50)	35 (31.8)	< 0.0001
LAD, n (%)	15 (30)	27 (45)	42 (38.2)	0.107
RAD, n (%)	-	3 (5)	3 (2.7)	0.249
Q wave, n (%)	9 (18)	17 (28.3)	26 (23.6)	0.204
Wide QRS, n (%)	10 (20)	43 (71.7)	53 (48.2)	< 0.0001
QRS duration, ms (± SD)	97.3 ± 20.7	124 ± 30.4
LBBB, n (%)	-	12 (20)	12 (10.9)	0.001
RBBB, n (%)	7 (14)	3 (5)	10 (9.1)	0.181
ST-T changes, n (%)	19 (38)	42 (70)	61 (55.4)	0.001
Prolong QT, n (%)	19 (38)	50 (83.3)	69 (62.7)	< 0.0001
Interval QTc, ms (± SD)	453.2 ± 42.8	499 ± 50.9

Table 3. ECG Basic Characteristics Based on Heart Failure Type

ECG parameter

HFpEF (n = 50)

HFrEF (n = 60)

Total (n = 110)

LAH: left atrial hypertrophy; LVH: left ventricular hypertrophy; LAD: left axis deviation; RAD: right axis deviation; LBBB: left bundle branch block; RBBB: right bundle branch block.

LAH, n (%)

6 (12)

22 (36.7)

28 (25.5)

0.003

LVH, n (%)

15 (30)

33 (55)

48 (43.6)

0.008

Poor R wave, n (%)

5 (10)

30 (50)

35 (31.8)

< 0.0001

LAD, n (%)

15 (30)

27 (45)

42 (38.2)

0.107

RAD, n (%)

3 (5)

3 (2.7)

0.249

Q wave, n (%)

9 (18)

17 (28.3)

26 (23.6)

0.204

Wide QRS, n (%)

10 (20)

43 (71.7)

53 (48.2)

< 0.0001

QRS duration, ms (± SD)

97.3 ± 20.7

124 ± 30.4

LBBB, n (%)

12 (20)

12 (10.9)

0.001

RBBB, n (%)

7 (14)

3 (5)

10 (9.1)

0.181

ST-T changes, n (%)

19 (38)

42 (70)

61 (55.4)

0.001

Prolong QT, n (%)

19 (38)

50 (83.3)

69 (62.7)

< 0.0001

Interval QTc, ms (± SD)

453.2 ± 42.8

499 ± 50.9

**Table 4.** ECG Variable Multivariate Analysis Variable ECG With Logistic Regression to Test the Possibility of Systolic Heart Failure or HFrEF (n = 110)
ECG parameter	OR	IK 95%	P
*Statistically significant. #n.a. LAH: left atrial hypertrophy; LVH: left ventricular hypertrophy; LAD: left axis deviation; RAD: right axis deviation; LBBB: left bundle branch block; RBBB: right bundle branch block.
LVH	1.24	0.284 - 5.407	0.774
Poor R wave	2.004	0.423 - 9.494	0.381
LAD	0.661	0.161 - 2.708	0.565
RAD	#	#	#
Q wave	3.756	0.947 - 14.891	0.060
LBBB	#	#	#
LAH	4.449	1.109 - 17.848	0.035*
Wide QRS	12.657	3.277 - 48.895	< 0.0001*
RBBB	0.109	0.012 - 0.986	0.049*
ST-T changes	4.35	1.277 - 14.817	0.019*
Prolong QT	7.401	2.134 - 25.672	0.002*

Table 4. ECG Variable Multivariate Analysis Variable ECG With Logistic Regression to Test the Possibility of Systolic Heart Failure or HFrEF (n = 110)

ECG parameter

IK 95%

*Statistically significant. #n.a. LAH: left atrial hypertrophy; LVH: left ventricular hypertrophy; LAD: left axis deviation; RAD: right axis deviation; LBBB: left bundle branch block; RBBB: right bundle branch block.

LVH

1.24

0.284 - 5.407

0.774

Poor R wave

2.004

0.423 - 9.494

0.381

LAD

0.661

0.161 - 2.708

0.565

RAD

Q wave

3.756

0.947 - 14.891

0.060

LBBB

LAH

4.449

1.109 - 17.848

0.035*

Wide QRS

12.657

3.277 - 48.895

< 0.0001*

RBBB

0.109

0.012 - 0.986

0.049*

ST-T changes

4.35

1.277 - 14.817

0.019*

Prolong QT

7.401

2.134 - 25.672

0.002*

**Table 5.** Calculated Score for Each ECG Variable Resulting From the Multivariate Analysis
ECG parameter	B	SE	B/SE	(B/SE)/x	Score
LAH: left atrial hypertrophy; RBBB: right bundle branch block.
LAH	1.493	0.709	2.105	1.068	1
Wide QRS	2.538	0.69	3.678	1.865	2
RBBB	-2.214	1.123	-1.971	-1	-1
ST-T changes	1.47	0.625	2.352	1.192	1
Prolong QT	2.002	0.635	3.152	1.599	2

Table 5. Calculated Score for Each ECG Variable Resulting From the Multivariate Analysis

ECG parameter

B/SE

(B/SE)/x

Score

LAH: left atrial hypertrophy; RBBB: right bundle branch block.

LAH

1.493

0.709

2.105

1.068

Wide QRS

2.538

0.69

3.678

1.865

RBBB

-2.214

1.123

-1.971

-1

ST-T changes

1.47

0.625

2.352

1.192

Prolong QT

2.002

0.635

3.152

1.599

**Table 6.** Scoring System Based on the Probability of Systolic Heart Failure (HFrEF)
Score	Probability (%)
-1	0.9
0	3.16
1	10.4
2	29.3
3	59.6
4	84
5	94.9
6	98.5

Table 6. Scoring System Based on the Probability of Systolic Heart Failure (HFrEF)

Score

Probability (%)

-1

0.9

3.16

10.4

29.3

59.6

94.9

98.5

**Table 7.** Sensitivity and Specificity for Each Point From Graph (Figure 1) Subjected to the Possibility of the Patient to Having Either HFpEF or HFrEF
No.	Positive if greater than or equal to	Sensitivity	1 - specificity	Sensitivity	Specificity
1	-2.0000	1.000	1.000	1.000	0.000
2	-0.5000	1.000	0.980	1.000	0.020
3	0.5000	1.000	0.700	1.000	0.300
4	1.5000	0.950	0.520	0.950	0.480
5	2.5000	0.867	0.260	0.867	0.740
6	3.5000	0.700	0.040	0.700	0.960
7	4.5000	0.483	0.020	0.483	0.980
8	5.5000	0.117	0.000	0.117	1.000
9	7.0000	0.000	0.000	0.000	1.000

Table 7. Sensitivity and Specificity for Each Point From Graph (Figure 1) Subjected to the Possibility of the Patient to Having Either HFpEF or HFrEF

No.

Positive if greater than or equal to

Sensitivity

1 - specificity

Sensitivity

Specificity

-2.0000

1.000

0.000

-0.5000

1.000

0.980

1.000

0.020

0.5000

1.000

0.700

1.000

0.300

1.5000

0.950

0.520

0.950

0.480

2.5000

0.867

0.260

0.867

0.740

3.5000

0.700

0.040

0.700

0.960

4.5000

0.483

0.020

0.483

0.980

5.5000

0.117

0.000

0.117

1.000

7.0000

0.000

1.000

**Table 8.** Validity Test Based on the Scoring System of Heart Failure Patients (n = 50)
Scoring system	ECHO (gold standard)
HFpEF: heart failure preserved ejection fraction; HFrEF: heart failure reduced ejection fraction.
HFrEF (+4 SD +6)	19	1
HFpEF (-1 SD +3)	6	24

Table 8. Validity Test Based on the Scoring System of Heart Failure Patients (n = 50)

Scoring system

ECHO (gold standard)

HFrEF (EF ≤ 40%)

HFpEF (EF > 40%)

HFpEF: heart failure preserved ejection fraction; HFrEF: heart failure reduced ejection fraction.

HFrEF (+4 SD +6)

HFpEF (-1 SD +3)