Relationship between the Selvester QRS Score and Coronary Microvascular Dysfunction Assessed by the Index of Microcirculatory Resistance.

Objective The index of microvascular resistance (IMR) is an invasive method for quantifying the coronary microvasculature independent of the presence and degree of epicardial stenosis during cardiac catheterization, whereas the Selvester QRS score, which is related to myocardial damage, is a relatively simple and non-invasive measurement procedure. We investigated the relationship between the QRS score and coronary microvascular dysfunction (CMD) assessed via IMR. Methods Data from 74 patients who underwent invasive coronary physiological measurements were retrospectively reviewed. Using a coronary wire, we measured IMR by the hyperemic mean transit time and distal coronary pressure. We also determined a simplified QRS score following the Selvester QRS score criteria by 12-lead electrocardiography. After determining the best cutoff value for the QRS score to predict IMR ≥25, which was defined as CMD by the Coronary Vasomotion Disorders International Study Group, patients were categorized into the QRS score ≥3 (n=16) and the QRS score 0-2 (n=58) groups. Results IMR in the QRS score ≥3 group was significantly higher in comparison to the QRS score 0-2 group (31; IQR: 19-57 vs. 20; IQR: 14-29, p<0.01). The percentage of patients with IMR ≥25 in the QRS score ≥3 group was significantly higher than that in the QRS score 0-2 group (69% vs. 34%, p=0.01). Conclusion A higher QRS score was associated with CMD, as estimated by IMR. The Selvester QRS score is noninvasive parameter that is potentially useful for predicting CMD.

O Escore de Selvester QRS é um Preditor de Mortalidade na Insuficiência Cardíaca com Fração de Ejeção Preservada / Selvester QRS Score is a Predictor of Mortality in Heart Failure with Preserved Ejection Fraction

Resumo Fundamento O escore Selvester QRS (S-QRS) em um eletrocardiograma (ECG) de 12 derivações está associado tanto à quantidade de cicatriz miocárdica quanto ao mau prognóstico em pacientes com infarto do miocárdio. Entretanto, seu valor prognóstico na insuficiência cardíaca (IC) com fração de ejeção preservada (ICFEp) é desconhecido. Objetivo Este estudo tem como objetivo investigar o valor preditivo do escore S-QRS para mortalidade na ICFEp. Métodos 359 pacientes foram incluídos retrospectivamente neste estudo. As características eletrocardiográficas, ecocardiográficas e laboratoriais dos pacientes foram registradas. O escore S-QRS simplificado foi medido e registrado. O tempo médio de seguimento dos pacientes foi de 38,1±9,5 meses. A significância estatística foi estabelecida em p < 0,05. Resultados Dos 359 pacientes, 270 estavam no grupo sobrevivente e 89 no grupo falecido. Idade, PCR-us, troponina, pro-BNP, diâmetro do átrio esquerdo (AE), índice de volume do AE, duração do QRS, Tpe e escore do S-QRS foram estatisticamente altos no grupo falecido. Na análise de regressão logística multivariada, idade, PCR-us, NT-proBNP, diâmetro do AE, índice de volume do AE, Tpe e escore S-QRS mostraram-se fatores de risco independentes para mortalidade. Na análise da característica operacional do receptor (ROC), o valor de corte do escore S-QRS foi de 5,5, a sensibilidade foi de 80,8% e a especificidade foi de 77,2% (AUC: 0,880, p:0,00). Na análise de Kaplan-Meier, verificou-se que a mortalidade foi maior no grupo com escore S-QRS ≥ 5,5 do que no grupo com escore S-QRS < 5,5. (Long-rank, p:0,00) Conclusão Acreditamos que o escore S-QRS pode ser usado como um indicador prognóstico de mortalidade a longo prazo em pacientes com ICFEp.

Abstract Background The Selvester QRS (S-QRS) score on a 12-lead electrocardiogram (ECG) is associated with both the amount of myocardial scar and poor prognosis in myocardial infarction patients. However, its prognostic value in heart failure (HF) with preserved ejection fraction (HFpEF) is unknown. Objective This study aims to investigate the predictive value of the S-QRS score for mortality in HFpEF. Methods 359 patients were retrospectively enrolled in this study. Electrocardiographic, echocardiographic, and laboratory features of the patients were recorded. The simplified S-QRS score was measured and recorded. The mean follow-up time of the patients was 38.1±9.5 months. Statistical significance was set at p < 0.05. Results Of 359 patients, 270 were in the survivor group, and 89 were in the deceased group. Age, Hs-CRP, troponin, pro-BNP, left atrial (LA) diameter, LA volume index, QRS duration, Tpe, and S-QRS score were statistically high in the deceased group. In multivariate logistic regression analysis, age, Hs-CRP, NT-proBNP, LA diameter, LA volume index, Tpe, and S-QRS score were shown to be independent risk factors for mortality. In the receiver-operating characteristic (ROC) analysis, the cut-off value of the S-QRS score was 5.5, the sensitivity was 80.8%, and the specificity was 77.2% (AUC:0.880, p:0.00). In Kaplan-Meier analysis, it was found that mortality was higher in the group with S-QRS score ≥ 5.5 than in the group with S-QRS score < 5.5. (Long-rank, p:0.00) Conclusions We think that the S-QRS score can be used as a prognostic indicator of long-term mortality in patients with HFpEF.

QRS score: A simple marker to quantify the extent of myocardial scarring in patients with chronic total arterial occlusion.

Background: Chronic total occlusion (CTO) is a critical and unique subgroup of coronary lesions. This study aimed to investigate the correlation between the Selvester QRS score and late gadolinium enhancement cardiac magnetic resonance imaging (LGE-CMRI) in quantifying myocardial scarring to provide a simple and feasible method for treating CTO. Methods: The medical records of 134 patients with absolute CTO who underwent coronary angiography between May 1, 2014 and December 30, 2017 were retrospectively reviewed. All patients were grouped according to the CTO location (right coronary artery [RCA] CTO, left artery descending [LAD] CTO, left circumflex [LCX] CTO, and multivessel CTO groups). The degree of myocardial scarring was determined according to the Selvester QRS score and using the LGE-CMRI. All patients were followed up for at least 12 months. Results: Among the 62 CTO patients, 55 had occlusion of a single vessel and seven had occlusion of multiple vessels, of which 27 (43.55%) were in the RCA CTO group, 16 (25.81%) in the LAD CTO group, 12 (19.35%) in the LCX CTO group, and 7 (11.29%) in the multivessel CTO group. The area under the receiver operating characteristic curve for the QRS score that was used to determine the degree of myocardial scarring was 0.806, with a sensitivity and specificity of 94.7% and 42.1%, respectively. The Selvester QRS score and LGE-CMRI measures of scar size were correlated in the RCA CTO, LCX CTO, and multivessel CTO groups (r = 0.466, 0.593, and 0.775, respectively). Conclusion: The Selvester QRS score was feasible for detecting myocardial scarring in patients with CTO.

Selvester QRS score predicts improvement of LVEF in atrial fibrillation patients with systolic heart failure.

BACKGROUND: Left-ventricular systolic dysfunction (LVSD) comorbid with atrial fibrillation is reversible, but recovery is limited in a subset of patients. The Selvester QRS (S-QRS) score is an electrocardiogram-based assessment that reportedly reflects myocardial scar/damage. We evaluated the predictability of S-QRS score for the recovery of left-ventricular ejection fraction (LVEF) in persistent AF (PeAF) patients with LVSD undergoing catheter ablation (CA). METHOD: CA was performed in 51 PeAF patients with reduced LVEF (<40%); S-QRS scores were measured after restoration of sinus rhythm. LVEF was re-evaluated at one year after CA; LVEF recovery was related to the S-QRS score. RESULTS: The median [interquartile range] S-QRS score was 1 point [0-2]. LVEF increased from 32% [28-37] at baseline to 56% [49-57] at 1 year after CA. Thirty-seven patients achieved normalization of LVEF (≥50%, Group A); 14 patients did not (Group B). Group A had significantly lower S-QRS scores than Group B (0 point [0-2] vs. 2 points [2-3], p < .05). In univariate/multivariate analyses, S-QRS score was an independent predictor of LVEF normalization. In the receiver operating characteristic curve, the cut-off value of S-QRS score was 2 points for prediction of the LVEF normalization (AUC = 0.79). Patients with low S-QRS score (<2 points) had greater LVEF improvement than those with high S-QRS score (≥2 points, ΔLVEF: 23% [17-28] vs. 17% [12-24], p < .05). CONCLUSION: S-QRS scoring noninvasively assesses the improvement of LVEF in PeAF patients with LVSD after CA. A high S-QRS score may indicate underlying myocardial scar/damage associated with unknown etiologies for LVSD other than PeAF.

Predictive role of Frontal QRS-T angle and Selvester QRS Score in determining angiographic slow flow phenomenon following percutaneous coronary intervention in patients with Non-ST elevation myocardial infarction.

AIM: Slow flow (SF) that develops after percutaneous coronary intervention (PCI) is significantly associated with poor prognosis in Non-ST elevation myocardial infarction (Non-STEMI) patients. Increased Selvester QRS score and Frontal QRS-T angle [f(QRS-T)] are related to adverse cardiovascular outcomes. We aimed to investigate the predictive role of the Selvester QRS score and f(QRS-T) for the development of post-PCI SF in patients with Non-STEMI. METHOD AND RESULTS: In a retrospective study, 210 patients with Non-STEMI were divided into two groups as SF (29) and Non-SF (181) according to their TIMI coronary flow grade. For all patients the Selvester QRS score and f(QRS-T) were calculated from automatic electrocardiography (ECG) reports. The mean age of the study population was 63 (55-75) years and 102 (68.6%) of patients were male. The Selvester QRS score and f(QRS-T) were higher in the SF group than in the Non-SF group [(5[3-8], 3[2-5]); (67° [42°-88°], 39° [24°-59°]), respectively, all p <0.01]. In a logistic regression analysis, the Selvester QRS score (OR = 4,862; 95% (CI) = 1,131-20,904, p =0.03) and f(QRS-T) (OR = 5,489; 95% (CI)= 11,433-21,034, p =0.01) were found independent predictors of post-PCI SF in Non-STEMI patients. Receiver operating characteristic (ROC) analysis was performed to assess the diagnostic values of the Selvester QRS score [86% sensitivity; 44% specificity; cut off 2; (AUC, 0.693)] and f(QRS-T) [62% sensitivity; 73% specificity; cut off 58°; (AUC, 0.778)]. CONCLUSION: The Selvester QRS score and f(QRS-T), both easy-to-calculate ECG parameters, are predictors of post-PCI SF in Non-STEMI patients.

Predictive role of Selvester QRS score in patients undergoing transcatheter aortic valve replacement.

INTRODUCTION: Few data exist regarding the late clinical impact of the Selvester score prediction of myocardial fibrosis after transcatheter aortic valve replacement (TAVR). This study evaluated the predictive power of the Selvester score on survival in patients with aortic stenosis (AS) undergoing TAVR. METHODS AND RESULTS: Patients with severe AS who had preoperative electrocardiograms were included. Clinical follow-up was obtained retrospectively. The primary endpoint was all-cause mortality. Secondary endpoints were cardiovascular death and major adverse cardiac events (MACEs). Two-hundred twenty-eight patients were included (mean age, 81.5 ± 7.4 years; women, 58.3%). Deceased patients had a higher mean score (4.6 ± 3.2 vs. 1.4 ± 1.3; p < .001). At a mean follow-up of 36.2 ± 21.2 months, the Selvester score was independently associated with all-cause mortality (hazard ratio [HR], 1.65; 95% confidence interval [CI], 1.48-1.84; p < .001), cardiovascular death (HR, 1.59; 95% CI, 1.38-1.74; p < .001), and MACE (HR, 1.55; 95% CI, 1.30-1.68; p < .001). After 5 years, the mortality risk was incrementally related to the Selvester score. The involvement of the inferior wall of the left ventricle was a lower mortality risk factor (HR, 0.42; 95% CI, 0.18-0.98; p = .046). For a Selvester score of 3, the area under the curve showed 0.92, 0.94, and 0.86 (p < .001), respectively, for 1, 2, and 3 years. CONCLUSIONS: Elevated Selvester scores increase the risk of poor outcomes in patients with AS undergoing TAVR. The involvement of the anterior or lateral wall presents worse prognosis.

Differences in the Selvester QRS score after primary PCI strategy and conservative treatment for STEMI patients with negative T waves.

BACKGROUND: According to current guidelines, the main indications for PCI in patients with STEMI are ST-segment deviations and defined time from the onset of symptoms. Negative T wave at admission can be a sign of prolonged ischemia or spontaneous reperfusion. In both situations, the urgent intervention is questionable. We evaluated the infarct size and in-hospital mortality in STEMI patients with negative T wave in cases of primary PCI strategy compared with conservative treatment. METHODS: A retrospective analysis of 116 STEMI patients with negative T wave at the presenting ECG was performed. Sixty-eight patients (59%) underwent primary PCI strategy (PCI group), and 48 (41%) were treated conservatively (non-PCI group). The infarct size estimated by using the Selvester score, and in-hospital mortality were evaluated. RESULTS: The difference between Selvester score values at admission and at discharge in the non-PCI group was statistically significant (1.48; 95% CI 0.694-2.27), while no significant difference was observed in the PCI group (-0.07; 95% CI -0.546-0.686). The in-hospital mortality was higher in the non-PCI group; however, the numbers were relatively small: PCI 2 (2.9%) and non-PCI 5 (10.4%). CONCLUSION: In this study, we showed a reduction in the infarct size estimated by Selvester score in STEMI patients with negative T wave who were treated conservatively, while there was no significant change in the infarct size after primary PCI strategy. The higher mortality in patients treated conservatively could be attributed to higher age and comorbidities in the non-PCI group. It seems that conservative treatment strategy might be an option in STEMI patients with negative T wave.

The ability of the electrocardiogram in left bundle branch block to detect myocardial scar determined by cardiovascular magnetic resonance.

AIMS: We aimed to improve the electrocardiographic 2009 left bundle branch block (LBBB) Selvester QRS score (2009 LBSS) for scar assessment. METHODS: We retrospectively identified 325 LBBB patients with available ECG and cardiovascular magnetic resonance imaging (CMR) with late gadolinium enhancement from four centers (142 [44%] with CMR scar). Forty-four semi-automatically measured ECG variables pre-selected based on the 2009 LBSS yielded one multivariable model for scar detection and another for scar quantification. RESULTS: The 2009 LBSS achieved an area under the curve (AUC) of 0.60 (95% confidence interval 0.54-0.66) for scar detection, and R2 = 0.04, p < 0.001, for scar quantification. Multivariable modeling improved scar detection to AUC 0.72 (0.66-0.77) and scar quantification to R2 = 0.21, p < 0.001. CONCLUSIONS: The 2009 LBSS detects and quantifies myocardial scar with poor accuracy. Improved models with extensive comparison of ECG and CMR had modest performance, indicating limited room for improvement of the 2009 LBSS.

Automatically computed ECG algorithm for the quantification of myocardial scar and the prediction of mortality.

BACKGROUND: Myocardial scar is associated with adverse cardiac outcomes. The Selvester QRS-score was developed to estimate myocardial scar from the 12-lead ECG, but its manual calculation is difficult. An automatically computed QRS-score would allow identification of patients with myocardial scar and an increased risk of mortality. OBJECTIVES: To assess the diagnostic and prognostic value of the automatically computed QRS-score. METHODS: The diagnostic value of the QRS-score computed automatically from a standard digital 12-lead was prospectively assessed in 2742 patients with suspected myocardial ischemia referred for myocardial perfusion imaging (MPI). The prognostic value of the QRS-score was then prospectively tested in 1151 consecutive patients presenting to the emergency department (ED) with suspected acute heart failure (AHF). RESULTS: Overall, the QRS-score was significantly higher in patients with more extensive myocardial scar: the median QRS-score was 3 (IQR 2-5), 4 (IQR 2-6), and 7 (IQR 4-10) for patients with 0, 5-20 and > 20% myocardial scar as quantified by MPI (p < 0.001 for all pairwise comparisons). A QRS-score ≥ 9 (n = 284, 10%) predicted a large scar defined as > 20% of the LV with a specificity of 91% (95% CI 90-92%). Regarding clinical outcomes in patients presenting to the ED with symptoms suggestive of AHF, mortality after 1 year was 28% in patients with a QRS-score ≥ 3 as opposed to 20% in patients with a QRS-score < 3 (p = 0.001). CONCLUSIONS: The QRS-score can be computed automatically from the 12-lead ECG for simple, non-invasive and inexpensive detection and quantification of myocardial scar and for the prediction of mortality. TRIAL-REGISTRATION: http://www.clinicaltrials.gov . Identifier, NCT01838148 and NCT01831115.

Electrocardiography scar quantification correlates with scar size of hypertrophic cardiomyopathy seen by multidetector computed tomography.

BACKGROUND: Hypertrophic cardiomyopathy (HCM), a genetically transmitted disease, is the most common genetic cardiovascular disease. Current strategies to stratify risk are expensive and concentrated in wealthy centers. Twelve-lead electrocardiography (ECG) is inexpensive, universally available, and can be readily used for Selvester QRS scoring, which estimates scar size. This study aimed to establish the relation between ECG scar quantification and myocardial fibrosis (extent of myocardial delayed enhancement) in multidetector computed tomography (MDCT). HYPOTHESIS: There is a significant association between ECG scar quantification and the extent of myocardial delayed enhancement in MDCT. METHODS: Seventy-five patients with HCM underwent a routine clinical evaluation and echocardiography, 12-lead ECG, and MDCT study. Patients with and without an implantable cardioverter-defibrillator were included. RESULTS: The estimated Selvester QRS score of myocardial fibrosis was correlated significantly (R = 0.70; P < 0.01) with the quantified MDCT fibrosis. Compared with MDCT, the QRS score had 84.8% sensitivity and 88.8% specificity. Myocardial fibrosis was present in 88% of these patients with HCM (fibrotic mass, 9.87 ±10.8 g) comprising 5.66% ±6.16% of the total myocardial mass seen on the MDCT images. The Selvester QRS score reliably predicted the fibrotic mass in 76% of patients, which estimated 8.44% ±7.39% of the total myocardial mass. CONCLUSIONS: The Selvester QRS score provides reliable quantification of myocardial fibrosis and was well correlated with MDCT in patients with HCM.

Semi-automated QRS score as a predictor of survival in CRT treated patients with strict left bundle branch block.

BACKGROUND: Cardiac Resynchronization Therapy (CRT) is widely used for treating selected heart failure patients, but patients with myocardial scar respond worse to treatment. The Selvester QRS scoring system estimates myocardial scar burden using 12-lead ECG. This study's objective was to investigate the scores correlation to mortality in a CRT population. METHODS AND RESULTS: Data on consecutive CRT patients was collected. 401 patients with LBBB and available ECG data were included in the study. QuAReSS software was used to perform Selvester scoring. Mean Selvester score was 6.4, corresponding to 19% scar burden. The endpoint was death or heart transplant; outcome was analyzed using Cox proportional hazards models. A Selvester score >8 was significantly associated with higher risk of the combined endpoint (HR 1.59, p=.014, CI 1.09-2.3). CONCLUSION: Higher Selvester scores correlate to mortality in CRT patients with strict LBBB and might be of value in prognosticating survival.

Reservations about the Selvester QRS score in left bundle branch block - Experience in patients with transcatheter aortic valve implantation.

BACKGROUND: The Selvester QRS score (S-score) estimates myocardial scar using electrocardiographic criteria. We evaluated the S-score for left bundle branch block (LBBB). MATERIAL AND METHODS: Studied were 36 patients who developed persistent LBBB upon transcatheter aortic valve implantation (TAVI, TAVI-LBBB group) and 36 matched patients with persistent narrow QRS (TAVI-nQRS group). Electrocardiograms were recorded before and briefly after TAVI and during ~6months follow-up. S-score was calculated using criteria for hypertrophic (in absence of LBBB) or LBBB hearts. RESULTS: In TAVI-LBBB patients correlation between S-scores pre-TAVI and post-TAVI was absent (R2=0.023). High S-scores post-TAVI occurred in patients with low pre-TAVI scores. Pre-post TAVI scores correlated weakly in TAVI-nQRS (R2=0.182), indicating a possible influence of ventricular unloading by TAVI. In both groups S-scores at post-TAVI and follow-up compared reasonably (R2=0.389 and R2=0.386), indicating reproducibility in more stable conditions. CONCLUSION: This study indicates that the use of the LBBB S-score criteria overestimates scar size and that caution is recommended in the use of the score in patients with LBBB.

Electrocardiographic measurement of infarct size compared to cardiac MRI in reperfused first time ST-segment elevation myocardial infarction.

BACKGROUND: Myocardial infarct size (IS) following ST-segment elevation myocardial infarction (STEMI) is an important prognostic factor. We assessed the Selvester 32-point QRS score from the 12-lead ECG for measurement of IS in STEMI patients receiving reperfusion therapy compared to cardiac magnetic resonance imaging (CMRI). Furthermore we sought to explore the impact of microvascular obstruction (MVO) on the scoring system, and determine factors contributing to discrepancies between CMRI IS and Selvester score. METHODS: We examined 70 patients (55 men, 15 women), mean age 57±10years with a first time STEMI (46 anterior, 24 non-anterior). QRS scores were calculated early and at follow-up (mean 2±1 and 59±14days post-STEMI). Myocardial core scar size (5SD) was measured at 5.3±3.3 and 57.8±13.5days post-infarction by CMRI. MVO was determined on initial MRI. Logistic regression analysis was performed to determine factors contributing to discordant scores, defined as a difference between CMRI and Selvester IS of >6% myocardium. RESULTS: QRS scoring of anterior infarcts correlated with CMRI IS both early (r=0.734, p<0.0001) and at follow-up (r=0.716, p<0.0001); however no correlation was seen among non-anterior infarcts. QRS scoring overestimated IS at all time points. There was better agreement between ECG and CMRI measured IS in patients without MVO at both time points. Anterior infarction was inversely predictive of discordant IS estimation acutely, and larger Selvester scores were predictive of inaccurate scoring at both time periods. CONCLUSIONS: Selvester QRS score correlates well with CMRI IS for anterior infarcts. MVO did not independently affect the score.

Automatic QRS Selvester scoring system in patients with left bundle branch block.

AIMS: The Selvester QRS scoring system uses quantitative criteria from the standard 12-lead electrocardiogram (ECG) to estimate the myocardial scar size of patients, including those with left bundle branch block (LBBB). Automation of the scoring system could facilitate the clinical use of this technique which requires a set of multiple QRS patterns to be identified and measured. METHODS AND RESULTS: We developed a series of algorithms to automatically detect and measure the QRS parameters required for Selvester scoring. The 'QUantitative and Automatic REport of Selvester Score' was designed specifically for the analysis of ECGs from patients meeting new strict criteria for complete LBBB. The algorithms were designed using a training (n = 36) and a validation (n = 180) set of ECGs, consisting of signal-averaged 12-lead ECGs (1000 Hz sampling) recorded from 216 LBBB patients from the MADIT-CRT. We assessed the performance of the methods using expert manually adjudicated ECGs. The average of absolute differences between automatic and adjudicated Selvester scoring was 1.2 ± 1.5 points. The range of average differences for continuous measurements of wave locations and interval durations varied between 0 and 6 ms. Erroneous detection of Q, R, S, R', and S' waves (oversensed or missed) were 3, 1, 1, 16, and 6%, respectively. Seven percent of notches detected in the first 40 ms were misdetected. CONCLUSION: We propose an efficient computerized method for the automatic measurement of the Selvester score in patients with the strict LBBB.

QRS-based assessment of myocardial damage and adverse events associated with cardiac sarcoidosis.

BACKGROUND: Cardiac sarcoidosis (CS) generates myocardial scar and arrhythmogenic substrate. CS diagnosis according to the Japanese Ministry of Health and Welfare guidelines relies, among others, on cardiac magnetic resonance imaging with late gadolinium enhancement (CMR-LGE). However, access to CMR-LGE is limited. The electrocardiography-based Selvester QRS score has been validated for identifying myocardial scar in ischemic/nonischemic cardiomyopathy, but its efficacy has not been tested to evaluate CS. OBJECTIVE: The purpose of this study was to examine whether the QRS score can be applied to CS. METHODS: CS-associated myocardial scar was assessed by both CMR-LGE and QRS scoring in patients with extra-CS (n = 59). RESULTS: Of 59 patients, 35 (59%) were diagnosed with CS according to the Japanese Ministry of Health and Welfare guidelines. QRS-estimated scar mass positively correlated with that quantified by CMR-LGE (signal intensity ≥2SD above the reference; r = 0.68; P < .001). Receiver operating characteristic curves demonstrated optimal cutoffs of 9% CMR-LGE scar and 3-point QRS score to identify patients with CS. The areas under the curves of CMR-LGE and the QRS score were not significantly different (0.83 and 0.78, respectively; P = .27); both methods demonstrated similar diagnostic performance. A QRS score of ≥3 led to a higher incidence of CS-associated adverse events (death/fatal arrhythmia/heart failure hospitalization) than did a QRS score of <3 (35 ± 21 months of follow-up; P = .01). QRS score was an independent predictor of risk in multivariate analysis (P = .03). CONCLUSION: The Selvester QRS scoring estimates CS-associated myocardial damage and identifies patients with CS equally well as CMR-LGE. A higher QRS score is also associated with an increased risk of life-threatening events in CS, indicating its potential use as a risk predictor.

Diagnostic performance of the Selvester QRS scoring system in relation to clinical ECG assessment of patients with lateral myocardial infarction using cardiac magnetic resonance as reference standard.

BACKGROUND: The Selvester QRS scoring system has previously been shown to enable estimation of myocardial infarct (MI) size by quantitative evaluation of the 12-lead ECG. The aim of this study was to assess the system's ability to detect and quantify lateral MI, using cardiac magnetic resonance (CMR) as reference standard. METHODS: In 23 patients with isolated lateral infarctions MI size was assessed by CMR and estimated by QRS scoring. The ECGs were also evaluated by two cardiologists according to clinical routine. RESULTS: The MI size estimated by QRS scoring correlated with MI size assessed by CMR (r=0.55, p=0.006). The sensitivity for lateral MI detection was 78% for QRS scoring and 39% for clinical routine ECG evaluation, respectively. CONCLUSION: Selvester QRS scoring can be used to estimate size of isolated lateral MI and has a higher sensitivity for infarct detection compared to clinical routine evaluation of ECGs in these patients.

Specificity for each of the 46 criteria of the Selvester QRS score for electrocardiographic myocardial scar sizing in left bundle branch block.

BACKGROUND: The Selvester QRS score consists of a set of electrocardiographic criteria designed to identify, quantify and localize scar in the left ventricle using the morphology of the QRS complex. These criteria were updated in 2009 to expand their use to patients with underlying conduction abnormalities, but these versions have thus far only been validated in small and carefully selected populations. AIM: To determine the specificity for each of the criteria of the left bundle branch block (LBBB) modified Selvester QRS Score (LB-SS) in a population with strict LBBB and no myocardial scar as verified by cardiovascular magnetic resonance imaging with late gadolinium enhancement (CMR-LGE). METHODS: We identified ninety-nine patients with LBBB without scar on CMR-LGE, who underwent a clinically indicated CMR scan at three different centers. The ECG recording date was any time prior to or <30days after the CMR scan. The LB-SS was applied and specificity for detection of scar in each of the 46 separate criteria was determined. RESULTS: The specificity ranged between 41% and 100% for the 46 criteria of LB-SS and 27/46 (59%) met ≥95% specificity. The mean±SD specificity was 90%±14%. CONCLUSION: Several of the criteria in the LB-SS lack adequate specificity. Elimination or modification of these nonspecific QRS morphology criteria may improve the specificity of the overall LB-SS.

Influence of QRS infarct score and QRS duration prior to transcatheter aortic valve replacement on follow-up left ventricular end systolic volume in patients with new persistent left bundle branch block.

BACKGROUND: New-onset left bundle branch block (LBBB) is a known complication during Transcatheter Aortic Valve Replacement (TAVR). This study evaluated the influence of pre-TAVR cardiac conditions on left ventricular functions in patients with new persistent LBBB post-TAVR. METHODS: Only 11 patients qualified for this study because of the strict inclusion criteria. Pre-TAVR electrocardiograms were evaluated for Selvester QRS infarct score and QRS duration, and left ventricular end-systolic volume (LVESV) was used as outcome variable. RESULTS: There was a trend towards a positive correlation between QRS score and LVESV of r=0.59 (p=0.058), while there was no relationship between QRS duration and LVESV (r=-0.18 [p=0.59]). CONCLUSION: This study showed that patients with new LBBB and higher pre-TAVR QRS infarct score may have worse post-TAVR left ventricular function, however, pre-TAVR QRS duration has no such predictive value. Because of the small sample size these results should be interpreted with caution and assessed in a larger study population.

Electrocardiogram score for the selection of reperfusion strategy in early latecomers with ST-segment elevation myocardial infarction.

OBJECTIVE: The clinical benefit of percutaneous coronary intervention (PCI) is controversial in ST-segment elevation myocardial infarction (STEMI) patients presenting 12-72 hours after symptom onset. Several studies suggested this conflicting result was associated with myocardial area at risk (MaR) of enrolled patients. MaR could be estimated by the electrocardiogram (ECG) score. Our objective was to evaluate the benefits of PCI in STEMI latecomers with different MaR. METHODS: We constructed a prospective cohort involving 436 patients presenting 12-72 hours after STEMI onset and who met an inclusion criteria. 218 underwent PCI and 218 received the optimal medical therapy (OMT) alone. Individual MaR was quantified by the combined Aldrich ST and Selvester QRS score. The primary endpoint was a composite of cardiovascular death, reinfarction or revascularization within two years. RESULTS: The 2-year cumulative primary endpoint rate was respectively 9.2% in PCI group and 5.3% in OMT group when MaR<35% (adjusted hazard ratio for PCI vs. OMT, 1.855; 95% confidence interval [CI], 0.617-5.575; P=0.271), and was 12.8% in PCI group and 23.1% in OMT group when MaR ≥35% (adjusted hazard ratio for PCI vs. OMT, 0.448; 95% CI, 0.228-0.884; P=0.021). CONCLUSION: The benefit of PCI for the STEMI latecomers was associated with the MaR. PCI, compared with OMT, could significantly reduce the 2-year primary outcomes in patients with MaR≥35%, but not in ones with MaR<35%.