- In this paper, a new distortion measure for electrocardiogram (ECG) signal compression, called weighted diagnostic distortion (WDD) is introduced. The WDD measure is designed for comparing the distortion between original ECG signal and reconstructed ECG signal (after compression). The WDD is based on PQRST complex diagnostic features (such as P wave duration, QT interval, T shape, ST elevation) of the original ECG signal and the reconstructed one. Unlike other conventional distortion measures [e.g. percentage root mean square (rms) difference, or PRD], the WDD contains direct diagnostic information and thus is more meaningful and useful. Four compression algorithms were implemented (AZTEC, SAPA2, LTP, ASEC) in order to evaluate the WDD. A mean opinion score (MOS) test was applied to test the quality of the reconstructed signals and to compare the quality measure (MOS/sub error/) with the proposed WDD measure and the popular PRD measure. The evaluators in the WIGS test were three independent expert cardiologists, who studied the reconstructed ECG signals in a blind and a semiblind tests. The correlation between the proposed WDD measure and the MOS test measure (MOS/sub error/) was found superior to the correlation between the popular PRD measure and the MOS/sub error/.