Evaluating Goldberger's triad as a marker of congestive heart failure: A systematic review and retrospective study.
Publication/Presentation Date
1-1-2023
Abstract
BACKGROUND: In 1982, Drs. Barold and Goldberger described an ECG triad associated with left ventricular dysfunction (LVD) consisting of high precordial QRS voltage, low limb lead voltage, and poor precordial R wave progression. Studies have since attempted to replicate the originally reported sensitivity (70%), specificity (>99%), and positive predictive value (PPV, 100%) of Goldberger's triad (GT) with variable results.
PURPOSE: To assess sensitivity, specificity and PPV of GT as a screening tool for LVD in the current era.
METHODS: We performed: (1) A systematic review of the published studies; (2) Searched our hospital ECG database (GE MUSE) for diagnoses of "low limb-voltage" and "left ventricular hypertrophy" from 2017 to 2022; identified ECGs were analyzed for GT criteria and their medical records were screened for LVD. (3) ECG analysis of patients with known idiopathic LVD for the GT.
RESULTS: A total of 11,115 patients from 8 studies were included in the systematic review of published studies and showed widely varying sensitivity, specificity and PPV. A total of 4576 ECGs (in GE MUSE) from 372 patients met initial screening criteria of low limb lead voltage and LVH; only 12 patients had ECGs that satisfied GT. Of these 12, only 1 patient had evidence of LVD, yielding a PPV of 8%. Finally, of the 40 patients with known LVD, only 1 met the ECG criteria for GT, resulting in a sensitivity of 2.5%.
CONCLUSION: Our literature review does not support the original results of GT. ECGs from our database that met GT (searched by low limb-voltage and left ventricular hypertrophy) over a span of 5 years were rare. When present, the PPV of GT was 8%. In patients with established LVD, the sensitivity was 2.5%. These data do not validate GT as tool to identify LVD in the current era.
Volume
81
First Page
207
Last Page
213
ISSN
1532-8430
Published In/Presented At
Saraiya, A., Yu, J., Huang, C., Frisch, D., & Pavri, B. B. (2023). Evaluating Goldberger's triad as a marker of congestive heart failure: A systematic review and retrospective study. Journal of electrocardiology, 81, 207–213. https://doi.org/10.1016/j.jelectrocard.2023.09.009
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
37783013
Department(s)
Administration and Leadership
Document Type
Article