Serial Modified Selvester QRS Score Trajectories as Predictors of Left Ventricular Functional Recovery Following Primary Percutaneous Coronary Intervention in Patients with First ST-Segment Elevation Myocardial Infarction

Q: What are the key findings of this study?

Admission Modified Selvester QRS score independently predicted 3-month left ventricular global longitudinal strain (β=0.245, p<0.001), with better strain after successful vs non-successful reperfusion (−17.17% vs −12.81%, p<0.001).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: First ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (n=185). Intervention: Serial Modified Selvester QRS score and successful myocardial reperfusion (TIMI grade 3 flow, myocardial blush grade ≥2, and ≥50% ST-segment resolution at 90 minutes) vs. Non-successful myocardial reperfusion. Primary outcome: Three-month left ventricular global longitudinal strain (GLS, %) (Cohen's d 1.16 (Admission QRS score multivariable B 0.398, standardized β 0.245), 95% CI 0.177-0.619, p=<0.001).

Q: What does this research mean for the field?

Admission Modified Selvester QRS score independently predicts 3-month left ventricular global longitudinal strain following primary PCI in patients with first STEMI, with serial score trajectories reflecting myocardial reperfusion success. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To determine whether serial Modified Selvester QRS score trajectories are associated with surrogate markers of reperfusion quality and predict three-month left ventricular functional recovery measured by global longitudinal strain after primary percutaneous coronary intervention for first STEMI.

Adel Magdy Hasaballa; Mohamed Kamal Salama; Osama Abouelfetouh Elshaer; Mohamed Gamil Abd Elraouf; Ahmed Mostafa Ahmed; Wael Anwar Elshahat Hassib

doi:10.47144/phj.v59i5.3756

August 27, 2026Pakistan Heart JournalOpen Access

Serial Modified Selvester QRS Score Trajectories as Predictors of Left Ventricular Functional Recovery Following Primary Percutaneous Coronary Intervention in Patients with First ST-Segment Elevation Myocardial Infarction

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Key result

Higher admission Modified Selvester QRS score is linked to worse 3-month LV strain.

Cohen's d −1.16 (Admission QRS score multivariable B 0.398, standardized β 0.245)
95% CI 0.177-0.619
P<0.001
n=185

Why the study?

Whether serial Modified Selvester QRS score trajectories are associated with surrogate markers of reperfusion quality and predict left ventricular functional recovery measured by global longitudinal strain three months after primary PCI for first STEMI was uncertain.

Do serial Modified Selvester QRS score trajectories reflect myocardial reperfusion quality and predict three-month left ventricular functional recovery (measured by global longitudinal strain) in patients with a first STEMI undergoing primary PCI?

Key Points

To determine whether serial Modified Selvester QRS score trajectories are associated with surrogate markers of reperfusion quality and predict three-month left ventricular functional recovery measured by global longitudinal strain after primary percutaneous coronary intervention for first STEMI.
Enrolled 185 consecutive patients presenting with a first ST-segment elevation myocardial infarction who underwent guideline-directed primary percutaneous coronary intervention in a single-centre prospective cohort study.
Measured Modified Selvester QRS scores on admission, 18–24 hours post-PCI, and at three months; assessed global longitudinal strain by echocardiography within 24 hours and at three months.
Defined successful reperfusion using a composite endpoint of final TIMI grade 3 flow, myocardial blush grade ≥2, and ≥50% ST-segment resolution 90 minutes after reperfusion.
Successful reperfusion was achieved in 131 patients (70.8%), with serial QRS trajectories differing significantly between reperfusion groups over time (F(2,366)=19.33, P<0.001).
Successfully reperfused patients showed stable QRS scores over the first 24 hours followed by improvement at three months, whereas non-successful reperfusion patients exhibited early and persistent score elevations.
Multivariable analysis identified admission Modified Selvester QRS score (β=0.245, P<0.001), corrected TIMI frame count (β=0.233, P=0.002), baseline GLS (β=0.207, P=0.001), and peak CK-MB (β=0.138, P=0.045) as independent predictors of three-month GLS.

Study Design

Type

Cohort (n=185)

Blinding

Blinded outcome assessment

Multicenter

No

Structured PICO

Do serial Modified Selvester QRS score trajectories reflect myocardial reperfusion quality and predict three-month left ventricular functional recovery (measured by global longitudinal strain) in patients with a first STEMI undergoing primary PCI?

P

Population

185 adults (mean age 57.8 years, 27.6% female) presenting within 12 hours of a first acute STEMI treated with primary PCI, free of prior MI, conduction abnormalities, or cardiogenic shock, followed for 3 months.

E

Exposure

Guideline-directed primary percutaneous coronary intervention (pPCI) with serial Modified Selvester QRS score assessment (on admission, 18–24 hours after PCI, and at three-month follow-up) and successful reperfusion (defined as a composite of final TIMI grade 3 flow, myocardial blush grade ≥2, and ≥50% ST-segment resolution at 90 minutes; n=131)

C

Comparator

Non-successful reperfusion following guideline-directed primary PCI (failing to meet the composite criteria of final TIMI grade 3 flow, myocardial blush grade ≥2, and ≥50% ST-segment resolution at 90 minutes; n=54)

O

Outcome

Left ventricular functional recovery measured by three-month global longitudinal strain (GLS) via 2D speckle-tracking echocardiography, analyzed as a continuous outcome adjusted for baseline GLS measured within 24 hours following reperfusionsurrogate

Main Result

Standardized Mean Difference: 1.16

Absolute Event Rate: -17.17% vs -12.81%

p-value: p=<0.001

Limitations

Single-centre observational design limiting generalizability
Infarct size and microvascular obstruction were not directly assessed using cardiac magnetic resonance imaging
Sample size was powered primarily for reperfusion comparison rather than longitudinal mixed-effects modeling, multivariable regression, or exploratory ROC analyses
ROC cutoff values were derived and evaluated within the same cohort without external validation
Residual confounding and lack of individual discharge medication data during follow-up
Short 3-month follow-up without assessment of long-term clinical events such as mortality or heart failure hospitalization
Single-center observational design
ROC cutoff values for impaired functional recovery were both derived and evaluated within the same cohort, making these thresholds exploratory and requiring external validation

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Implication

Serial Modified Selvester QRS scoring is a simple, inexpensive bedside tool that tracks microvascular reperfusion quality and independently predicts 3-month left ventricular functional recovery (by GLS) after primary PCI for first STEMI.

Abstract

Objectives: This study aimed to determine whether serial Modified Selvester QRS score trajectories are associated with surrogate markers of reperfusion quality and predict left ventricular functional recovery measured by global longitudinal strain (GLS) three months after primary percutaneous coronary intervention (pPCI). Methodology: This prospective single-centre cohort study enrolled 185 consecutive patients presenting with first ST-segment elevation myocardial infarction (STEMI) who underwent guideline-directed primary PCI. Successful reperfusion was defined using a composite endpoint consisting of final TIMI grade 3 flow, myocardial blush grade ≥2, and ≥50% ST-segment resolution 90 minutes after reperfusion. Modified Selvester QRS scores were measured on admission, 18–24 hours after PCI, and at three-month follow-up. Echocardiographic assessment of GLS was performed within 24 hours following reperfusion and repeated after three months. Results: Successful reperfusion was achieved in 131 patients (70.8%). Serial Modified Selvester QRS trajectories differed significantly according to reperfusion status, with a significant time-by-reperfusion interaction (F(2,366)=19.33, P<0.001). Patients achieving successful reperfusion demonstrated stable QRS scores during the first 24 hours followed by significant improvement at three months, whereas patients with non-successful reperfusion exhibited an early increase in QRS score that remained persistently elevated throughout follow-up. Multivariable analysis identified admission Modified Selvester QRS score (β=0.245, P<0.001), corrected TIMI frame count (β=0.233, P=0.002), baseline GLS (β=0.207, P=0.001), and peak CK-MB (β=0.138, P=0.045) as independent predictors of three-month GLS. Conclusion: Serial Modified Selvester QRS score trajectories were independently associated with surrogate measures of myocardial reperfusion quality and subsequent left ventricular functional recovery following primary PCI for first STEMI.

Discussion

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Cite This Study

Hasaballa et al. (2026) conducted a cohort in First ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (n=185). Serial Modified Selvester QRS score and successful myocardial reperfusion (TIMI grade 3 flow, myocardial blush grade ≥2, and ≥50% ST-segment resolution at 90 minutes) vs. Non-successful myocardial reperfusion was evaluated on Three-month left ventricular global longitudinal strain (GLS, %) (Cohen's d 1.16 (Admission QRS score multivariable B 0.398, standardized β 0.245), 95% CI 0.177-0.619, p=<0.001). Admission Modified Selvester QRS score independently predicted 3-month left ventricular global longitudinal strain (β=0.245, p<0.001), with better strain after successful vs non-successful reperfusion (−17.17% vs −12.81%, p<0.001).

synapsesocial.com/papers/6af0db863c845ca7837ced44 https://doi.org/10.47144/phj.v59i5.3756

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Serial Modified Selvester QRS Score Trajectories as Predictors of Left Ventricular Functional Recovery Following Primary Percutaneous Coronary Intervention in Patients with First ST-Segment Elevation Myocardial Infarction

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Serial Modified Selvester QRS Score Trajectories as Predictors of Left Ventricular Functional Recovery Following Primary Percutaneous Coronary Intervention in Patients with First ST-Segment Elevation Myocardial Infarction

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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