| Goldberger's Electrocardiographic Triad in Patients With Echocardiographic Severe Left Ventricular Dysfunction. | |
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MedLine Citation:
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PMID: 22177001 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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In 1982, Goldberger described an electrocardiographic triad (SV(1) or SV(2) + RV(5) or RV(6) ≥3.5 mV, total QRS amplitude in each of the limb leads ≤0.8 mV, and R/S ratio <1 in lead V(4)) that was 70% sensitive and >90% specific for detecting severe left ventricular (LV) dysfunction. To confirm his sensitivity results, in 51 consecutive patients (36 men) aged 28 to 84 years (mean 56) with LV ejection fractions ≤20%, the electrocardiographic triad was sought in the electrocardiogram (ECG) recorded closest in time to the echocardiographic study. All 51 patients had systemic arterial hypertension. Evidence of ischemia was present in 7 and absent in 38, and in 6 patients, ischemic status was unknown. In 49 patients, New York Heart Association functional class was available: class II in 8, class III in 32, and class IV in 9. LV ejection fractions ranged from 4% to 20% (mean 14%), and LV internal end-diastolic diameters ranged from 5.7 to 8.6 cm (mean 6.6). Left atrial anteroposterior diameters ranged from 2.9 to 6.1 cm (mean 4.7) and were ≥4.0 cm in 47 of the 51 patients. The right ventricular cavity was enlarged in 22 patients. SV(1) or SV(2) + RV(5) or RV(6) was ≥3.5 mV in 29 of the 51 ECGs; total QRS amplitude was ≤0.8 mV in each of leads I, II, and III in 10; and the R/S ratio was <1 in lead V(4) in 37. Only 1 of the 51 ECGs met all 3 criteria. In contrast to Goldberger's finding of the triad to be 70% sensitive for severe LV dysfunction, in this study, the triad was found to be only 2% sensitive. The difference is likely due to his patients' having idiopathic dilated cardiomyopathy, whereas those in this study had hypertensive cardiomyopathy with or without ischemia. Also, in this study, 1 specific ECG was used for each patient, whereas Goldberger reviewed all of the patients' ECGs looking for the triad. In conclusion, Goldberger's triad is a sensitive or insensitive marker for severe LV dysfunction depending on the patient population and the number of ECGs reviewed. |
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Authors:
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Christina Lopez; Camelia C Ilie; D Luke Glancy; Roberto E Quintal |
Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-12-15 |
Journal Detail:
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Title: The American journal of cardiology Volume: - ISSN: 1879-1913 ISO Abbreviation: - Publication Date: 2011 Dec |
Date Detail:
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Created Date: 2011-12-19 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0207277 Medline TA: Am J Cardiol Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Copyright Information:
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Copyright © 2012 Elsevier Inc. All rights reserved. |
Affiliation:
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Section of Cardiology, Department of Medicine, Louisiana State University, Health Sciences Center, New Orleans, Louisiana, USA; Section of Cardiology, Department of Medicine, Interim LSU Public Hospital, New Orleans, Louisiana, USA. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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