Determination of Diastolic Dysfunction by Single Lead Electrocardiogram
Condition: Diastolic Function
Study type: Observational

Summary: 
      It is a prospective, controlled, single-center, non-randomized, observational study.

      From September 2019 to December 2020, the study plans to prospectively include 400 patients
      aged 18 to 90 years.

      Every patients will undergo an echocardiographic examination with assessment diastolic
      dysfunction of the left ventricle, and registration of an electrocardiogram using a single
      lead ECG monitor CardioQvark (in I standard lead) for 3 minutes. All patients will be divided
      into 2 main groups: with diastolic dysfunction of the left ventricle, confirmed by the
      results of the echocardiography and without. A spectral analysis of the electrocardiogram
      will be performed using a continuous wavelet transform.

      The result of this study will be the identification of ECG parameters that will correlate
      with LV diastolic dysfunction.
    

Detailed description: 
      It is a prospective, controlled, single-center, non-randomized, observational study.

      From September 2019 to December 2020, the study plans to prospectively include 400 patients
      aged 18 to 90 years.

      The goal of study is reveal single parameters of the electrocardiogram, which a good
      correlation with left ventricular diastolic dysfunction (LV DD), discovered during
      echocardiography.

      Investigators plan to assess the diagnostic effectiveness of the spectral analysis of
      electrocardiograms obtained using a single-lead portable ECG monitor.

      All subjects will undergo an echocardiographic examination of the heart with a determination
      of diastolic dysfunction of the left ventricle and will be divided into 2 main groups: with
      diastolic dysfunction of the left ventricle, confirmed by the results of the echocardiography
      and without.

      At the same time, for all patients single-lead ECG will be recorded (in turn of leads I) for
      3 minutes with further spectral analysis of the data obtained.

      A single-lead ECG monitor CardioQvark is designed as an iPhone cover. It is registered with
      the Federal Service for Health Supervision on February 15, 2019. RZN No. 2019/8124.

      Then a spectral analysis of the electrocardiogram will be performed using a continuous
      wavelet transform, the principles of which are based on the Fourier transform.

      The analysis implies an assessment of the following parameters (the parameters listed below
      will be calculated as the median of the tact-cycle):

        -  TpTe - time from peak to end of the T-wave

        -  VAT - time from the beginning of the QRS to the R-peak

        -  QTc - corrected QT interval.

        -  QT / TQ - the ratio of QT length to TQ length (from the end of T to the beginning of the
           QRS of the next complex).

        -  QRS_E - the total energy of the QRS wave based on the wavelet transform

        -  T_E - T-wave total energy based on wavelet transform

        -  TP_E- energy of the main tooth of the T-wave based on the wavelet transform

        -  BETA, BETA_S - T-wave asymmetry coefficients (simple and smooth versions)

        -  BAD_T - flag of T-wave quality (whether expressed in the current lead

        -  QRS_D1_ons - energy of the leading edge of the R-wave (based on the "first derivative"
           wavelet transform)

        -  QRS_D1_offs - energy of the trailing edge of the R-wave (based on the "first derivative"
           wavelet transform)

        -  QRS_D2 - peak energy of the R-wave (based on the "second derivative" wavelet transform)

        -  QRS_Ei (i = 1,2,3,4) - QRS-wave energy in 4 frequency ranges (2-4-8-16-32 Hz) based on
           wavelet transform

        -  T_Ei (i = 1,2,3,4) - T-wave energy in 4 frequency ranges (2-4-6-8-10 Hz) based on
           wavelet transform

        -  HFQRS - the amplitude of the RF components of the QRS wave

      Additionally used parameters:

        -  TpTe, VAT, QTc - are duplicated to control the correctness of the record processing (the
           value of the UCC should be approximately equal to the median of the tick-by-bar).

        -  QRSw - QRS width.

        -  RA, SA, TA - the amplitudes of the R, S, T-waves, respectively, are used to normalize
           the parameters listed above.

      Statistical processing of results: SPSS Statistics Version 26 is a computer program for
      statistical processing of data.

      The result of this study will be the identification of ECG parameters that will correlate
      with LV diastolic dysfunction, and by which it will be possible to determine its presence and
      degree in the future.

      Investigators also plan to analyze ECG parameters characteristic of patients with LV
      diastolic dysfunction in different population groups:

        -  patients suffering from high blood pressure with patients without the above pathology

        -  patients with zones of a- and hypokinesis according to echocardiography as a result of a
           coronary circulation disorder

        -  patients suffering from atrial fibrillation with patients without this pathology

        -  men / women

        -  patients of different age groups

      During statistical processing of the data, the following will be calculated: sensitivity,
      specificity, prognostic value of positive and negative results, likelihood ratio, area under
      ROC - curve, correlation coefficient. it is planned to obtain data on the diagnostic
      effectiveness of the proposed approach, as well as on individual parameters of the
      electrocardiogram in the diagnosis of diastolic dysfunction of the left ventricle.
    

Intervention name(s): echocardiographic examination
Intervention type(s): Device
Intervention description(s): conducting an echocardiographic study according to a standard protocol with the determination of diastolic dysfunction of the left ventricle
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        all patients aged 18 to 90 years
      
Keywords: diastolic function; heart failure; spectral analysis