Comparison of the "real-life" diagnostic value of two recently published electrocardiogram methods for the differential diagnosis of wide QRS complex tachycardias

Zsuzsanna Szelényi, G. Duray, Gábor Katona, Gábor Fritúz, Eszter Szego, Eniko Kovács, G. Szénási, András Vereckei

Research output: Contribution to journalArticle

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Abstract

Objectives: The diagnostic values of the aVR lead or "Vereckei algorithm," and the lead II R-wave peak time (RWPT) criterion, recently devised for the differential diagnosis of wide QRS complex tachycardias (WCTs), were compared. Methods: A total of 212 WCTs (142 ventricular tachycardias [VTs], 62 supraventricular tachycardias [SVT], and eight preexcitation SVTs) from 145 patients with proven electrophysiologic diagnoses were retrospectively analyzed by seven examiners blinded to the electrophysiologic diagnoses. Results: The overall test accuracy of the Vereckei algorithm was superior to that of the RWPT criterion (84.3% vs. 79.6%; p = 0.0003). The sensitivity of the Vereckei algorithm for VT diagnosis was greater than that of RWPT criterion (92.4% vs. 79.1%; p <0.0001). The negative predictive value (NPV) for the Vereckei algorithm was also greater (77.8%; 95% confidence interval [CI] = 73.6% to 82.1%) than that of the RWPT criterion (61.6%; 95% CI = 57.6% to 65.6%). The specificity of the Vereckei algorithm was lower than that of the RWPT criterion (64.7% vs. 80.9%; p <0.0001). The positive predictive value (PPV) was also lower for the Vereckei algorithm (86.4%; 95% CI = 84.4% to 88.4%) than for the RWPT criterion (90.9%; 95% CI = 89.1% to 92.8%). Incorrect diagnoses made by the Vereckei algorithm were mainly due to misdiagnosis of SVT as VT (65.7% of cases), and those made by the RWPT criterion were due to the more dangerous misdiagnosis of VT as SVT (72.5% of cases). Conclusions: The Vereckei algorithm was superior in overall test accuracy, sensitivity, and NPV for VT diagnosis and inferior in specificity and PPV to the RWPT criterion. All of these parameters were lower in "real life" than those reported by the original authors for each of the particular electrocardiographic methods.

Original languageEnglish
Pages (from-to)1121-1130
Number of pages10
JournalAcademic Emergency Medicine
Volume20
Issue number11
DOIs
Publication statusPublished - Nov 2013

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Value of Life
Tachycardia
Electrocardiography
Differential Diagnosis
Ventricular Tachycardia
Supraventricular Tachycardia
Confidence Intervals
Diagnostic Errors

ASJC Scopus subject areas

  • Emergency Medicine

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Comparison of the "real-life" diagnostic value of two recently published electrocardiogram methods for the differential diagnosis of wide QRS complex tachycardias. / Szelényi, Zsuzsanna; Duray, G.; Katona, Gábor; Fritúz, Gábor; Szego, Eszter; Kovács, Eniko; Szénási, G.; Vereckei, András.

In: Academic Emergency Medicine, Vol. 20, No. 11, 11.2013, p. 1121-1130.

Research output: Contribution to journalArticle

Szelényi, Zsuzsanna ; Duray, G. ; Katona, Gábor ; Fritúz, Gábor ; Szego, Eszter ; Kovács, Eniko ; Szénási, G. ; Vereckei, András. / Comparison of the "real-life" diagnostic value of two recently published electrocardiogram methods for the differential diagnosis of wide QRS complex tachycardias. In: Academic Emergency Medicine. 2013 ; Vol. 20, No. 11. pp. 1121-1130.
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abstract = "Objectives: The diagnostic values of the aVR lead or {"}Vereckei algorithm,{"} and the lead II R-wave peak time (RWPT) criterion, recently devised for the differential diagnosis of wide QRS complex tachycardias (WCTs), were compared. Methods: A total of 212 WCTs (142 ventricular tachycardias [VTs], 62 supraventricular tachycardias [SVT], and eight preexcitation SVTs) from 145 patients with proven electrophysiologic diagnoses were retrospectively analyzed by seven examiners blinded to the electrophysiologic diagnoses. Results: The overall test accuracy of the Vereckei algorithm was superior to that of the RWPT criterion (84.3{\%} vs. 79.6{\%}; p = 0.0003). The sensitivity of the Vereckei algorithm for VT diagnosis was greater than that of RWPT criterion (92.4{\%} vs. 79.1{\%}; p <0.0001). The negative predictive value (NPV) for the Vereckei algorithm was also greater (77.8{\%}; 95{\%} confidence interval [CI] = 73.6{\%} to 82.1{\%}) than that of the RWPT criterion (61.6{\%}; 95{\%} CI = 57.6{\%} to 65.6{\%}). The specificity of the Vereckei algorithm was lower than that of the RWPT criterion (64.7{\%} vs. 80.9{\%}; p <0.0001). The positive predictive value (PPV) was also lower for the Vereckei algorithm (86.4{\%}; 95{\%} CI = 84.4{\%} to 88.4{\%}) than for the RWPT criterion (90.9{\%}; 95{\%} CI = 89.1{\%} to 92.8{\%}). Incorrect diagnoses made by the Vereckei algorithm were mainly due to misdiagnosis of SVT as VT (65.7{\%} of cases), and those made by the RWPT criterion were due to the more dangerous misdiagnosis of VT as SVT (72.5{\%} of cases). Conclusions: The Vereckei algorithm was superior in overall test accuracy, sensitivity, and NPV for VT diagnosis and inferior in specificity and PPV to the RWPT criterion. All of these parameters were lower in {"}real life{"} than those reported by the original authors for each of the particular electrocardiographic methods.",
author = "Zsuzsanna Szel{\'e}nyi and G. Duray and G{\'a}bor Katona and G{\'a}bor Frit{\'u}z and Eszter Szego and Eniko Kov{\'a}cs and G. Sz{\'e}n{\'a}si and Andr{\'a}s Vereckei",
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T1 - Comparison of the "real-life" diagnostic value of two recently published electrocardiogram methods for the differential diagnosis of wide QRS complex tachycardias

AU - Szelényi, Zsuzsanna

AU - Duray, G.

AU - Katona, Gábor

AU - Fritúz, Gábor

AU - Szego, Eszter

AU - Kovács, Eniko

AU - Szénási, G.

AU - Vereckei, András

PY - 2013/11

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N2 - Objectives: The diagnostic values of the aVR lead or "Vereckei algorithm," and the lead II R-wave peak time (RWPT) criterion, recently devised for the differential diagnosis of wide QRS complex tachycardias (WCTs), were compared. Methods: A total of 212 WCTs (142 ventricular tachycardias [VTs], 62 supraventricular tachycardias [SVT], and eight preexcitation SVTs) from 145 patients with proven electrophysiologic diagnoses were retrospectively analyzed by seven examiners blinded to the electrophysiologic diagnoses. Results: The overall test accuracy of the Vereckei algorithm was superior to that of the RWPT criterion (84.3% vs. 79.6%; p = 0.0003). The sensitivity of the Vereckei algorithm for VT diagnosis was greater than that of RWPT criterion (92.4% vs. 79.1%; p <0.0001). The negative predictive value (NPV) for the Vereckei algorithm was also greater (77.8%; 95% confidence interval [CI] = 73.6% to 82.1%) than that of the RWPT criterion (61.6%; 95% CI = 57.6% to 65.6%). The specificity of the Vereckei algorithm was lower than that of the RWPT criterion (64.7% vs. 80.9%; p <0.0001). The positive predictive value (PPV) was also lower for the Vereckei algorithm (86.4%; 95% CI = 84.4% to 88.4%) than for the RWPT criterion (90.9%; 95% CI = 89.1% to 92.8%). Incorrect diagnoses made by the Vereckei algorithm were mainly due to misdiagnosis of SVT as VT (65.7% of cases), and those made by the RWPT criterion were due to the more dangerous misdiagnosis of VT as SVT (72.5% of cases). Conclusions: The Vereckei algorithm was superior in overall test accuracy, sensitivity, and NPV for VT diagnosis and inferior in specificity and PPV to the RWPT criterion. All of these parameters were lower in "real life" than those reported by the original authors for each of the particular electrocardiographic methods.

AB - Objectives: The diagnostic values of the aVR lead or "Vereckei algorithm," and the lead II R-wave peak time (RWPT) criterion, recently devised for the differential diagnosis of wide QRS complex tachycardias (WCTs), were compared. Methods: A total of 212 WCTs (142 ventricular tachycardias [VTs], 62 supraventricular tachycardias [SVT], and eight preexcitation SVTs) from 145 patients with proven electrophysiologic diagnoses were retrospectively analyzed by seven examiners blinded to the electrophysiologic diagnoses. Results: The overall test accuracy of the Vereckei algorithm was superior to that of the RWPT criterion (84.3% vs. 79.6%; p = 0.0003). The sensitivity of the Vereckei algorithm for VT diagnosis was greater than that of RWPT criterion (92.4% vs. 79.1%; p <0.0001). The negative predictive value (NPV) for the Vereckei algorithm was also greater (77.8%; 95% confidence interval [CI] = 73.6% to 82.1%) than that of the RWPT criterion (61.6%; 95% CI = 57.6% to 65.6%). The specificity of the Vereckei algorithm was lower than that of the RWPT criterion (64.7% vs. 80.9%; p <0.0001). The positive predictive value (PPV) was also lower for the Vereckei algorithm (86.4%; 95% CI = 84.4% to 88.4%) than for the RWPT criterion (90.9%; 95% CI = 89.1% to 92.8%). Incorrect diagnoses made by the Vereckei algorithm were mainly due to misdiagnosis of SVT as VT (65.7% of cases), and those made by the RWPT criterion were due to the more dangerous misdiagnosis of VT as SVT (72.5% of cases). Conclusions: The Vereckei algorithm was superior in overall test accuracy, sensitivity, and NPV for VT diagnosis and inferior in specificity and PPV to the RWPT criterion. All of these parameters were lower in "real life" than those reported by the original authors for each of the particular electrocardiographic methods.

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