Validation of CalECG software for primary prevention heart failure patients: Reducing inter-observer measurement variability

Nathan Engstrom; Geoffrey P Dobson; Kevin Ng; Krystle Lander; Kyi Win; Anudeep Gupta; Hayley L Letson

doi:10.1016/j.jelectrocard.2022.09.011

Validation of CalECG software for primary prevention heart failure patients: Reducing inter-observer measurement variability

J Electrocardiol. 2022 Sep-Oct:74:128-133. doi: 10.1016/j.jelectrocard.2022.09.011. Epub 2022 Sep 25.

Authors

Nathan Engstrom¹, Geoffrey P Dobson², Kevin Ng³, Krystle Lander⁴, Kyi Win⁵, Anudeep Gupta⁶, Hayley L Letson⁷

Affiliations

¹ College of Medicine & Dentistry, Heart and Trauma Research Laboratory, James Cook University, 1 James Cook Drive, Townsville, QLD 4811, Australia; Cardiac Investigations, Townsville University Hospital, 100 Angus Smith Drive, Douglas, QLD 4814, Australia. Electronic address: [email protected].
² College of Medicine & Dentistry, Heart and Trauma Research Laboratory, James Cook University, 1 James Cook Drive, Townsville, QLD 4811, Australia. Electronic address: [email protected].
³ Cardiology Clinic, Cairns Hospital, 165 Esplanade, Cairns, QLD 4870, Australia. Electronic address: [email protected].
⁴ Cardiology Department, Townsville University Hospital, 100 Angus Smith Drive, Douglas, QLD 4814, Australia. Electronic address: [email protected].
⁵ Cardiology Department, Townsville University Hospital, 100 Angus Smith Drive, Douglas, QLD 4814, Australia. Electronic address: [email protected].
⁶ Cardiology Department, Townsville University Hospital, 100 Angus Smith Drive, Douglas, QLD 4814, Australia. Electronic address: [email protected].
⁷ College of Medicine & Dentistry, Heart and Trauma Research Laboratory, James Cook University, 1 James Cook Drive, Townsville, QLD 4811, Australia. Electronic address: [email protected].

PMID: 36191576
DOI: 10.1016/j.jelectrocard.2022.09.011

Abstract

Background: In primary prevention heart failure patients the 12‑lead electrocardiogram (ECG) may be useful for the prediction of ventricular arrhythmias. However, inter-observer measurement variability first needs to be identified and any software used, validated.

Objective: To compare manual ECG measures with CalECG software and to assess the reliability of visual recognition of fragmented QRS (fQRS) by advanced cardiology trainees.

Methods: 30 pre-implant ECGs were assessed on patients who met guidelines for primary prevention Implantable Cardiac Defibrillator. Parameters included RR, PR, QT, QRS duration, axis location, fQRS and T wave peak to T wave end (TpTe). ECGs were analyzed by members of the cardiology department with different levels of experience, and compared to CalECG software. Interobserver agreement was assessed using Fleiss' Kappa (κ) and intraclass correlation coefficients (ICC). Pearson correlation coefficient (r) was used to compare human and software measures.

Results: Strong/very strong correlation was recorded across manual ECG measures (ICC = 0.749-0.979, p ≤ 0.0001) with moderate/strong correlation for TpTe (ICC = 0.547-0.765, p ≤ 0.001). Advanced cardiology trainees demonstrated substantial agreement on ECG interpretation (κ = 0.788, p ≤ 0.0001), however, reliability of fQRS assessment was only moderate for identification (κ = 0.5, p ≤ 0.0001) and fair for location (κ = 0.295, p = 0.001). CalECG software showed strong/very strong correlation with manual measurement for standard measures (r = 0.756-0.977, p ≤ 0.001). Concordance between human and software TpTe measurements varied between leads, with V5 showing a non-significant weak correlation (r = 0.197).

Conclusion: CalECG software showed strong/very strong correlation with standard manual measures which affirms its use in ECG analysis. Advanced cardiology trainees showed greater variability in the identification and location of fQRS.

Keywords: CalECG; Electrocardiogram; Fragmented QRS; Heart failure; Implantable cardiac defibrillator; Primary prevention.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Electrocardiography*
Heart Failure* / diagnosis
Heart Failure* / prevention & control
Humans
Primary Prevention
Reproducibility of Results