Determination of Diastolic Dysfunction by Single Lead Electrocardiogram

Study Overview
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Brief Summary
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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
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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.

Official Title
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Diastolic Dysfunction Assessment of the Left Ventricle Using Spectral Analysis of a Single Lead ECG

Conditions
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Diastolic Function

Intervention / Treatment
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* Device: echocardiographic examination


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: The presence of written informed consent of the patient to participate in the study Age from 18 years to 90 years Outpatient treatment and / or hospitalization in a research center Exclusion Criteria: Reluctance of the patient to participate in the study Poor quality ECG recording on a single-channel ECG monitor Poor visualization of the heart during echocardiographic study Acute psychotic reactions that arose during research An exacerbation of chronic diseases requiring treatment tactics for the patient and preventing his further participation in the study. Non-inclusion criteria: The presence of conduction disturbances in patients that impede ECG analysis (WPW syndrome, sinoatrial block of degrees 2 and 3, atrioventricular block 3 degrees, complete block of the left bundle branch block, complete block of the right bundle branch block) Conditions that can impair ECG recording quality (Parkinson's disease, essential tremor) The inability to assess diastolic function during echocardiography Mental illness Diseases with an expected life expectancy of less than 2 years Patients with diffuse hypokinesis of the left ventricle with a reduced ejection fraction (less than 30%) Patients with a pacemaker installed

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 90 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| with diastolic dysfunction<br>patients with diastolic dysfunction of the left ventricle confirmed by the results of the echocardiography (septal e' >=8, and lateral e'>=10 and left atrium <34 ml/m2) and by results of the spectral analysis of electrocardiogram (the parameters listed below will be calculated as the median of the tact-cycle: TpTe, VAT, QTc, QT / TQ, QRS_E, T_E, TP_E, BETA, BETA_S, BAD_T, QRS_D1_ons, QRS_D1_offs, QRS_D2, QRS_Ei (i = 1,2,3,4), T_Ei (i= 1,2,3,4), HFQRS, QRSw, RA, SA, TA). | Device: echocardiographic examination<br>* conducting an echocardiographic study according to a standard protocol with the determination of diastolic dysfunction of the left ventricle<br>|
| without diastolic dysfunction<br>patients without diastolic dysfunction of the left ventricle confirmed by the results of the echocardiography (septal e'<8, and lateral e'<10 and left atrium >=34 ml/m2) and by results of the spectral analysis of electrocardiogram (the parameters listed below will be calculated as the median of the tact-cycle: TpTe, VAT, QTc, QT / TQ, QRS_E, T_E, TP_E, BETA, BETA_S, BAD_T, QRS_D1_ons, QRS_D1_offs, QRS_D2, QRS_Ei (i = 1,2,3,4), T_Ei (i= 1,2,3,4), HFQRS, QRSw, RA, SA, TA). | Device: echocardiographic examination<br>* conducting an echocardiographic study according to a standard protocol with the determination of diastolic dysfunction of the left ventricle<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| determination of sensitivity of LV DD using a single-channel ECG monitor CardioQvark | comparison of the presence of LV DD detected by the results of an echocardiographic study with the results of the presence of LV DD obtained using the mathematical model of a single-channel ECG of the CardioQvark monitor | through study completion, an average of 2 years | 
| determination of specificity of LV DD using a single-channel ECG monitor CardioQvark | comparison of the presence of LV DD detected by the results of an echocardiographic study with the results of the presence of LV DD obtained using the mathematical model of a single-channel ECG of the CardioQvark monitor | through study completion, an average of 2 years | 
| determination of prognostic value of positive and negative results of LV DD using a single-channel ECG monitor CardioQvark | comparison of the presence of LV DD detected by the results of an echocardiographic study with the results of the presence of LV DD obtained using the mathematical model of a single-channel ECG of the CardioQvark monitor | through study completion, an average of 2 years | 
| determination of likelihood ratio of LV DD using a single-channel ECG monitor CardioQvark | comparison of the presence of LV DD detected by the results of an echocardiographic study with the results of the presence of LV DD obtained using the mathematical model of a single-channel ECG of the CardioQvark monitor | through study completion, an average of 2 years | 
| determination of area under ROC - curve of LV DD using a single-channel ECG monitor CardioQvark | comparison of the presence of LV DD detected by the results of an echocardiographic study with the results of the presence of LV DD obtained using the mathematical model of a single-channel ECG of the CardioQvark monitor | through study completion, an average of 2 years | 
| determination of correlation coefficient of LV DD using a single-channel ECG monitor CardioQvark | comparison of the presence of LV DD detected by the results of an echocardiographic study with the results of the presence of LV DD obtained using the mathematical model of a single-channel ECG of the CardioQvark monitor | through study completion, an average of 2 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| significance of the parameter TpTe on the ECG in the determination of LV DD | an ECG spectral analysis will be performed using the Fourier Transform | through study completion, an average of 2 years | 
| significance of the parameter VAT on the ECG in the determination of LV DD | an ECG spectral analysis will be performed using the Fourier Transform | through study completion, an average of 2 years | 
| significance of the parameter QTc on the ECG in the determination of LV DD | an ECG spectral analysis will be performed using the Fourier Transform | through study completion, an average of 2 years | 
| significance of the parameter QT / TQ on the ECG in the determination of LV DD | an ECG spectral analysis will be performed using the Fourier Transform | through study completion, an average of 2 years | 
| significance of the parameter QRS_E on the ECG in the determination of LV DD | an ECG spectral analysis will be performed using the Fourier Transform | through study completion, an average of 2 years | 
| significance of the parameter T_E on the ECG in the determination of LV DD | an ECG spectral analysis will be performed using the Fourier Transform | through study completion, an average of 2 years | 
| significance of the parameter TP_E on the ECG in the determination of LV DD | an ECG spectral analysis will be performed using the Fourier Transform | through study completion, an average of 2 years | 
| significance of the parameter BETA on the ECG in the determination of LV DD | an ECG spectral analysis will be performed using the Fourier Transform | through study completion, an average of 2 years | 
| significance of the parameter BETA_S on the ECG in the determination of LV DD | an ECG spectral analysis will be performed using the Fourier Transform | through study completion, an average of 2 years | 
| significance of the parameter BAD_T on the ECG in the determination of LV DD | an ECG spectral analysis will be performed using the Fourier Transform | through study completion, an average of 2 years | 
| significance of the parameter QRS_D1_ons on the ECG in the determination of LV DD | an ECG spectral analysis will be performed using the Fourier Transform | through study completion, an average of 2 years | 
| significance of the parameter QRS_D1_offs on the ECG in the determination of LV DD | an ECG spectral analysis will be performed using the Fourier Transform | through study completion, an average of 2 years | 
| significance of the parameter QRS_D2 on the ECG in the determination of LV DD | an ECG spectral analysis will be performed using the Fourier Transform | through study completion, an average of 2 years | 
| significance of the parameter QRS_Ei on the ECG in the determination of LV DD | an ECG spectral analysis will be performed using the Fourier Transform | through study completion, an average of 2 years | 
| significance of the parameter T_Ei on the ECG in the determination of LV DD | an ECG spectral analysis will be performed using the Fourier Transform | through study completion, an average of 2 years | 
| significance of the parameter HFQRS on the ECG in the determination of LV DD | an ECG spectral analysis will be performed using the Fourier Transform | through study completion, an average of 2 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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diastolic function, heart failure, spectral analysis