PT - JOURNAL ARTICLE AU - Eugene SJ Tan AU - Siew Pang Chan AU - Chang Fen Xu AU - Jonathan Yap AU - Arthur Mark Richards AU - Lieng Hsi Ling AU - David Sim AU - Fazlur Jaufeerally AU - Daniel Yeo AU - Seet Yoong Loh AU - Hean Yee Ong AU - Kui Toh Gerard Leong AU - Tze Pin Ng AU - Shwe Zin Nyunt AU - Liang Feng AU - Peter Okin AU - Carolyn SP Lam AU - Toon Wei Lim TI - Cornell product is an ECG marker of heart failure with preserved ejection fraction AID - 10.1136/heartasia-2018-011108 DP - 2019 May 01 TA - Heart Asia PG - e011108 VI - 11 IP - 1 4099 - http://heartasia.bmj.com/content/11/1/e011108.short 4100 - http://heartasia.bmj.com/content/11/1/e011108.full SO - Heart Asia2019 May 01; 11 AB - Objective ECG markers of heart failure (HF) with preserved ejection fraction (HFpEF) are lacking. We hypothesised that the Cornell product (CP) is a risk marker of HFpEF and has prognostic utility in HFpEF.Methods CP =[(amplitude of R wave in aVL+depth of S wave in V3)×QRS] was measured on baseline 12-lead ECG in a prospective Asian population-based study of 606 healthy controls (aged 55±10 years, 45% men), 221 hypertensive controls (62±9 years, 58% men) and 242 HFpEF (68±12 years, 49% men); all with EF ≥50% and followed for 2 years for all-cause mortality and HF hospitalisations.Results CP increased across groups from healthy controls to hypertensive controls to HFpEF, and distinguished between HFpEF and hypertension with an optimal cut-off of ≥1800 mm*ms (sensitivity 40%, specificity 85%). Age, male sex, systolic blood pressure (SBP) and heart rate were independent predictors of CP ≥1800 mm*ms, and CP was associated with echocardiographic E/e′ (r=0.27, p<0.01) and left ventricular mass index (r=0.46, p<0.01). Adjusting for clinical and echocardiographic variables and log N-terminal pro B-type natriuretic peptide (NT-proBNP), CP ≥1800 mm*ms was significantly associated with HFpEF (adjusted OR 2.7, 95% CI 1.0 to 7.0). At 2-year follow-up, there were 29 deaths and 61 HF hospitalisations, all within the HFpEF group. Even after adjusting for log NT-proBNP, clinical and echocardiographic variables, CP ≥1800 mm*ms remained strongly associated with a higher composite endpoint of all-cause mortality and HF hospitalisations (adjusted HR 2.1, 95% CI 1.2 to 3.5).Conclusion The Cornell product is an easily applicable ECG marker of HFpEF and predicts poor prognosis by reflecting the severity of diastolic dysfunction and LV hypertrophy.