Automatically computed ECG algorithm for the quantification of myocardial scar and the prediction of mortality
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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.
To assess the diagnostic and prognostic value of the automatically computed QRS-score.
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).
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).
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.
http://www.clinicaltrials.gov. Identifier, NCT01838148 and NCT01831115.
KeywordsSelvester QRS-score ECG Myocardial scar Heart failure Cardiac imaging
The authors thank the patients who participated in the study and the staff of the Department of Nuclear Medicine.
This study was supported by research Grants from the Swiss National Science Foundation, the Swiss Heart Foundation, the Cardiovascular Research Foundation Basel, the University Hospital Basel, Abbott and BRAHMS.
Compliance with ethical standards
Conflict of interest
Dr. Mueller has received research support from the Swiss National Science Foundation, the Swiss Heart Foundation, the Cardiovascular Research Foundation Basel, Abbott, Beckman Coulter, BRAHMS, Roche, Siemens. and the University Hospital Basel, as well as speaker honoraria from Abbott, ALERE, Astra Zeneca, BG Medicine, Biomerieux, Brahms, Cardiorentis, Lilly, Novartis, Roche, and Siemens. Dr. Reichlin has received research grants from the Goldschmidt-Jacobson Foundation, the Swiss National Science Foundation (PASMP3-136995) the Swiss Heart Foundation, the Professor Max Cloëtta Foundation, the Cardiovascular Research Foundation Basel, the University of Basel and the University Hospital Basel as well as speaker honoraria from Brahms and Roche. Dr. Twerenbold has received research support from the Swiss National Science Foundation (P300PB-167803/1) and speaker honoraria/consulting honoraria from Roche, Abbott, Siemens and Brahms. Dr. Boeddinghaus has received speaker honoraria from Siemens. All other authors declare that they have no conflict of interest with this study.
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