Key result
Selvester QRS score correlates modestly with CMR scar but fails to predict clinical outcomes.
Why the study?
Myocardial scar burden quantification is an emerging clinical parameter for risk stratification in patients with left ventricular dysfunction and LBBB, but the relationship between Selvester score and LGE-CMR scar burden and clinical outcome is unclear.
Cohort (n=60)
No
Effect estimate: r = 0.35
p-value: p=0.007
Selvester scoring should not guide scar-based risk stratification in LBBB-HF; leaves open whether refined ECG algorithms can match CMR for outcome prediction.
BACKGROUND: Myocardial scar burden quantification is an emerging clinical parameter for risk stratification of sudden cardiac death and prediction of ventricular arrhythmias in patients with left ventricular dysfunction. We investigated the relationships among semiautomated Selvester score burden and late gadolinium enhancement-cardiovascular magnetic resonance (LGE-CMR) assessed scar burden and clinical outcome in patients with underlying heart failure, left bundle branch block (LBBB) and implantable cardioverter-defibrillator (ICD) treatment. METHODS: Selvester QRS scoring was performed on all subjects with ischemic and nonischemic dilated cardiomyopathy at Skåne University Hospital Lund (2002-2013) who had undergone LGE-CMR and 12-lead ECG with strict LBBB pre-ICD implantation. RESULTS: Sixty patients were included; 57% nonischemic dilated cardiomyopathy and 43% ischemic cardiomyopathy with mean left ventricular ejection fraction of 27.6% ± 11.7. All patients had scar by Selvester scoring. Sixty-two percent had scar by LGE-CMR (n = 37). The Spearman correlation coefficient for LGE-CMR and Selvester score derived scar was r = .35 (p = .007). In scar negative LGE-CMR, there was evidence of scar by Selvester scoring in all patients (range 3%-33%, median 15%). Fourteen patients (23%) had an event during the follow-up period; 11 (18%) deaths and six adequate therapies (10%). There was a moderate trend indicating that presence of scar increased the risk of clinical endpoints in the LGE-CMR analysis (p = .045). CONCLUSION: There is a modest correlation between LGE-CMR and Selvester scoring verified myocardial scar. CMR based scar burden is correlated to clinical outcome, but Selvester scoring is not. The Selvester scoring algorithm needs to be further refined in order to be clinically relevant and reliable for detailed scar evaluation in patients with LBBB.
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Chaudhry et al. (2017) conducted a cohort in Heart failure with left bundle branch block (LBBB) (n=60). Selvester QRS scoring vs. Late gadolinium enhancement cardiovascular magnetic resonance (LGE-CMR) was evaluated on Correlation of myocardial scar burden and prediction of clinical outcomes (death or adequate ICD therapies) (r = 0.35, p=0.007). Selvester QRS scoring showed modest correlation with LGE-CMR for myocardial scar (r=0.35, p=0.007) but did not predict clinical outcomes, whereas CMR-assessed scar burden did (p=0.045).
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