Localization of myocardial scar in patients with cardiomyopathy and left bundle branch block using electrocardiographic Selvester QRS scoring

Björn Wieslander, Katherine C. Wu, Zak Loring, Linus G. Andersson, Terry F. Frank, Gary Gerstenblith, Gordon F. Tomaselli, Robert G. Weiss, Galen S. Wagner, Martin Ugander, David G. Strauss

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Introduction Outcome of cardiac resynchronization therapy is severely worsened by myocardial scar at the left ventricular (LV) pacing site. We aimed to describe the diagnostic performance of electrocardiographic (ECG) criteria based on the Selvester QRS scoring system, first in localizing myocardial scar and second in screening for any non-septal scar in patients with strictly defined LBBB. Methods and Results In 39 cardiomyopathy patients with LBBB, 17 with scar, 22 without scar, late gadolinium-enhancement cardiac magnetic resonance images (CMR-LGE) and 12-lead ECGs were analyzed for scar presence in 5 LV wall segments. The ECG criteria with the best diagnostic performance in detecting scar in each segment and in the four non-septal segments together were identified. Criteria for detecting non-septal scar had 75% (95% CI: 51%-90%) sensitivity, 95% (78%-99%) specificity, 92% (67%-99%) positive predictive value and 84% (65%-94%) negative predictive value. For each individual wall segment, 40%-60% sensitivities and 77%-100% specificities were found. Conclusions The 12-lead ECG can convey information about scar presence and location in this population of cardiomyopathy patients with LBBB. ECG screening criteria for scar in potential CRT LV pacing sites were identified. Further exploration is required to determine the clinical utility of the 12-lead ECG in combination with other imaging modalities to screen for scar in potential LV pacing sites in CRT candidates.

Original languageEnglish (US)
Pages (from-to)249-255
Number of pages7
JournalJournal of Electrocardiology
Volume46
Issue number3
DOIs
StatePublished - May 1 2013
Externally publishedYes

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Bundle-Branch Block
Cardiomyopathies
Cicatrix
Cardiac Resynchronization Therapy
Gadolinium
Electrocardiography
Magnetic Resonance Spectroscopy

Keywords

  • Cardiac resynchronization therapy
  • Cardiomyopathy
  • Left bundle branch block
  • Myocardial scar localization
  • Selvester QRS score

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Localization of myocardial scar in patients with cardiomyopathy and left bundle branch block using electrocardiographic Selvester QRS scoring. / Wieslander, Björn; Wu, Katherine C.; Loring, Zak; Andersson, Linus G.; Frank, Terry F.; Gerstenblith, Gary; Tomaselli, Gordon F.; Weiss, Robert G.; Wagner, Galen S.; Ugander, Martin; Strauss, David G.

In: Journal of Electrocardiology, Vol. 46, No. 3, 01.05.2013, p. 249-255.

Research output: Contribution to journalArticle

Wieslander, B, Wu, KC, Loring, Z, Andersson, LG, Frank, TF, Gerstenblith, G, Tomaselli, GF, Weiss, RG, Wagner, GS, Ugander, M & Strauss, DG 2013, 'Localization of myocardial scar in patients with cardiomyopathy and left bundle branch block using electrocardiographic Selvester QRS scoring', Journal of Electrocardiology, vol. 46, no. 3, pp. 249-255. https://doi.org/10.1016/j.jelectrocard.2013.02.006
Wieslander, Björn ; Wu, Katherine C. ; Loring, Zak ; Andersson, Linus G. ; Frank, Terry F. ; Gerstenblith, Gary ; Tomaselli, Gordon F. ; Weiss, Robert G. ; Wagner, Galen S. ; Ugander, Martin ; Strauss, David G. / Localization of myocardial scar in patients with cardiomyopathy and left bundle branch block using electrocardiographic Selvester QRS scoring. In: Journal of Electrocardiology. 2013 ; Vol. 46, No. 3. pp. 249-255.
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abstract = "Introduction Outcome of cardiac resynchronization therapy is severely worsened by myocardial scar at the left ventricular (LV) pacing site. We aimed to describe the diagnostic performance of electrocardiographic (ECG) criteria based on the Selvester QRS scoring system, first in localizing myocardial scar and second in screening for any non-septal scar in patients with strictly defined LBBB. Methods and Results In 39 cardiomyopathy patients with LBBB, 17 with scar, 22 without scar, late gadolinium-enhancement cardiac magnetic resonance images (CMR-LGE) and 12-lead ECGs were analyzed for scar presence in 5 LV wall segments. The ECG criteria with the best diagnostic performance in detecting scar in each segment and in the four non-septal segments together were identified. Criteria for detecting non-septal scar had 75{\%} (95{\%} CI: 51{\%}-90{\%}) sensitivity, 95{\%} (78{\%}-99{\%}) specificity, 92{\%} (67{\%}-99{\%}) positive predictive value and 84{\%} (65{\%}-94{\%}) negative predictive value. For each individual wall segment, 40{\%}-60{\%} sensitivities and 77{\%}-100{\%} specificities were found. Conclusions The 12-lead ECG can convey information about scar presence and location in this population of cardiomyopathy patients with LBBB. ECG screening criteria for scar in potential CRT LV pacing sites were identified. Further exploration is required to determine the clinical utility of the 12-lead ECG in combination with other imaging modalities to screen for scar in potential LV pacing sites in CRT candidates.",
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AU - Wieslander, Björn

AU - Wu, Katherine C.

AU - Loring, Zak

AU - Andersson, Linus G.

AU - Frank, Terry F.

AU - Gerstenblith, Gary

AU - Tomaselli, Gordon F.

AU - Weiss, Robert G.

AU - Wagner, Galen S.

AU - Ugander, Martin

AU - Strauss, David G.

PY - 2013/5/1

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N2 - Introduction Outcome of cardiac resynchronization therapy is severely worsened by myocardial scar at the left ventricular (LV) pacing site. We aimed to describe the diagnostic performance of electrocardiographic (ECG) criteria based on the Selvester QRS scoring system, first in localizing myocardial scar and second in screening for any non-septal scar in patients with strictly defined LBBB. Methods and Results In 39 cardiomyopathy patients with LBBB, 17 with scar, 22 without scar, late gadolinium-enhancement cardiac magnetic resonance images (CMR-LGE) and 12-lead ECGs were analyzed for scar presence in 5 LV wall segments. The ECG criteria with the best diagnostic performance in detecting scar in each segment and in the four non-septal segments together were identified. Criteria for detecting non-septal scar had 75% (95% CI: 51%-90%) sensitivity, 95% (78%-99%) specificity, 92% (67%-99%) positive predictive value and 84% (65%-94%) negative predictive value. For each individual wall segment, 40%-60% sensitivities and 77%-100% specificities were found. Conclusions The 12-lead ECG can convey information about scar presence and location in this population of cardiomyopathy patients with LBBB. ECG screening criteria for scar in potential CRT LV pacing sites were identified. Further exploration is required to determine the clinical utility of the 12-lead ECG in combination with other imaging modalities to screen for scar in potential LV pacing sites in CRT candidates.

AB - Introduction Outcome of cardiac resynchronization therapy is severely worsened by myocardial scar at the left ventricular (LV) pacing site. We aimed to describe the diagnostic performance of electrocardiographic (ECG) criteria based on the Selvester QRS scoring system, first in localizing myocardial scar and second in screening for any non-septal scar in patients with strictly defined LBBB. Methods and Results In 39 cardiomyopathy patients with LBBB, 17 with scar, 22 without scar, late gadolinium-enhancement cardiac magnetic resonance images (CMR-LGE) and 12-lead ECGs were analyzed for scar presence in 5 LV wall segments. The ECG criteria with the best diagnostic performance in detecting scar in each segment and in the four non-septal segments together were identified. Criteria for detecting non-septal scar had 75% (95% CI: 51%-90%) sensitivity, 95% (78%-99%) specificity, 92% (67%-99%) positive predictive value and 84% (65%-94%) negative predictive value. For each individual wall segment, 40%-60% sensitivities and 77%-100% specificities were found. Conclusions The 12-lead ECG can convey information about scar presence and location in this population of cardiomyopathy patients with LBBB. ECG screening criteria for scar in potential CRT LV pacing sites were identified. Further exploration is required to determine the clinical utility of the 12-lead ECG in combination with other imaging modalities to screen for scar in potential LV pacing sites in CRT candidates.

KW - Cardiac resynchronization therapy

KW - Cardiomyopathy

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KW - Myocardial scar localization

KW - Selvester QRS score

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