Heart failure (HF) is a growing global health concern, with its prevalence increasing among younger populations. Despite several clinical criteria being available for diagnosing HF, a reliable electrocardiographic (ECG) marker for early prediction remains lacking. Early detection of HF is critical for timely intervention and improved patient outcomes.
In this study, we introduce ventricular electrical dyssynchrony (VED)—a measure of interventricular conduction delay derived from precordial ECG leads—as a potential predictor of HF risk. VED is quantified in milliseconds by analyzing depolarization patterns across ventricular segments and calculating the interlead depolarization delays.
Leveraging data from the MIMIC-IV ECG database, we analyzed 19,974 subjects with no prior history of HF. HF incidence was extracted from the electronic health records based on ICD9/10 codes, along with time-to-event data, over a 12-year follow-up period. A total of 2,180 subjects developed HF during the study period. To assess the association between VED and future HF, we performed multivariate Cox regression analysis, adjusting for covariates such as age, sex, and QRS duration. VED was categorized into three distinct groups: Low VED (–20 to 15 ms), High-Negative VED (<–20 ms), and High-Positive VED (>15 ms).
The analysis revealed significant findings: compared to the Low VED group, the High-Negative VED group showed a hazard ratio (HR) of 1.55 (95% CI: 1.21–1.97, p<0.001), while the High-Positive VED group had an HR of 1.94 (95% CI: 1.49-2.52, p<0.0001). These results suggest that VED is strongly associated with an increased risk of developing heart failure.
Our findings highlight the potential of VED as an ECG-based biomarker for early heart failure risk stratification. However, further validation incorporating standard clinical HF markers, such as ejection fraction and natriuretic peptid levels, is necessary to confirm its clinical utility and diagnostic accuracy.