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Can QRS scoring predict left ventricular scar and clinical outcomes?

Can QRS scoring predict left ventricular scar and clinical outcomes?
Can QRS scoring predict left ventricular scar and clinical outcomes?
AIMS: Identifying patients with potential to benefit from implantable cardioverter defibrillator (ICD) therapy is challenging. Myocardial scar detected using cardiovascular myocardial resonance imaging with late gadolinium enhancement (CMR-LGE) is associated with ventricular arrhythmia. Its use is constrained due to limited availability, unlike electrocardiogram (ECG) which is widely available. Selvester QRS scoring detects scar, although the reported performance varies. The study aims were to determine whether QRS score (a) detects scar (b) varies with scar characteristics, and (c) can meaningfully predict sudden cardiac death.

METHODS AND RESULTS:
We investigated 64 consecutive ICD recipients (age 66 ± 11 years, 80% male, median left ventricular ejection fraction 30%) with coronary artery disease who had undergone CMR-LGE prior to device implantation, over 4 years in a single centre (2006-2009). A modified QRS score was measured on the ECG performed prior to ICD implantation. Clinical end points were (i) appropriate ICD therapy and (ii) all cause mortality. QRS score was associated with CMR scar (r = 0.42, P = 0.001) and scar surface area (r = 0.41, P = 0.001), but not subendocardial scar. Strongest correlation was seen in those patients with transmural scar only (r = 0.62, P = 0.01). During 42 ± 13 months follow-up, QRS score was not predictive of appropriate ICD therapy, but was significantly related to all cause mortality (hazard ratio = 1.16; confidence interval = 1.03-1.30; P = 0.01).

CONCLUSION:
QRS scoring performed best in quantifying transmural scar, and shows association with medium-term mortality risk, but not with risk of ventricular arrhythmia. It may be that the score is best suited as a risk stratifier of those with least potential to benefit from ICD
cardiac, coronary artery disease, implantable cardioverter defibrillator, magnetic resonance imaging, sudden death, arrhythmia, electrocardiogram
1099-5129
1034-1041
Rosengarten, James
3ccf8397-ca9e-4b04-864f-5c2515db8965
Scott, Paul A.
5a16b1f4-74d3-473f-9eeb-c2a823d690dc
Chiu, OK
0e8b220a-9781-4150-b39a-8d055bfd303c
Shambrook, JS
965056df-9574-4db2-a8c7-fda6ab9ed474
Curzen, N.
70f3ea49-51b1-418f-8e56-8210aef1abf4
Morgan, John M.
ac98099e-241d-4551-bc98-709f6dfc8680
Rosengarten, James
3ccf8397-ca9e-4b04-864f-5c2515db8965
Scott, Paul A.
5a16b1f4-74d3-473f-9eeb-c2a823d690dc
Chiu, OK
0e8b220a-9781-4150-b39a-8d055bfd303c
Shambrook, JS
965056df-9574-4db2-a8c7-fda6ab9ed474
Curzen, N.
70f3ea49-51b1-418f-8e56-8210aef1abf4
Morgan, John M.
ac98099e-241d-4551-bc98-709f6dfc8680

Rosengarten, James, Scott, Paul A., Chiu, OK, Shambrook, JS, Curzen, N. and Morgan, John M. (2013) Can QRS scoring predict left ventricular scar and clinical outcomes? Europace, 15 (7), 1034-1041. (doi:10.1093/europace/eut014). (PMID:23493411)

Record type: Article

Abstract

AIMS: Identifying patients with potential to benefit from implantable cardioverter defibrillator (ICD) therapy is challenging. Myocardial scar detected using cardiovascular myocardial resonance imaging with late gadolinium enhancement (CMR-LGE) is associated with ventricular arrhythmia. Its use is constrained due to limited availability, unlike electrocardiogram (ECG) which is widely available. Selvester QRS scoring detects scar, although the reported performance varies. The study aims were to determine whether QRS score (a) detects scar (b) varies with scar characteristics, and (c) can meaningfully predict sudden cardiac death.

METHODS AND RESULTS:
We investigated 64 consecutive ICD recipients (age 66 ± 11 years, 80% male, median left ventricular ejection fraction 30%) with coronary artery disease who had undergone CMR-LGE prior to device implantation, over 4 years in a single centre (2006-2009). A modified QRS score was measured on the ECG performed prior to ICD implantation. Clinical end points were (i) appropriate ICD therapy and (ii) all cause mortality. QRS score was associated with CMR scar (r = 0.42, P = 0.001) and scar surface area (r = 0.41, P = 0.001), but not subendocardial scar. Strongest correlation was seen in those patients with transmural scar only (r = 0.62, P = 0.01). During 42 ± 13 months follow-up, QRS score was not predictive of appropriate ICD therapy, but was significantly related to all cause mortality (hazard ratio = 1.16; confidence interval = 1.03-1.30; P = 0.01).

CONCLUSION:
QRS scoring performed best in quantifying transmural scar, and shows association with medium-term mortality risk, but not with risk of ventricular arrhythmia. It may be that the score is best suited as a risk stratifier of those with least potential to benefit from ICD

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More information

e-pub ahead of print date: 14 March 2013
Published date: July 2013
Keywords: cardiac, coronary artery disease, implantable cardioverter defibrillator, magnetic resonance imaging, sudden death, arrhythmia, electrocardiogram
Organisations: Human Development & Health

Identifiers

Local EPrints ID: 355247
URI: http://eprints.soton.ac.uk/id/eprint/355247
ISSN: 1099-5129
PURE UUID: 69bac3a7-7aa7-49f3-a15b-e9885d18a81e
ORCID for N. Curzen: ORCID iD orcid.org/0000-0001-9651-7829

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Date deposited: 19 Aug 2013 12:18
Last modified: 28 Apr 2022 01:55

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Contributors

Author: James Rosengarten
Author: Paul A. Scott
Author: OK Chiu
Author: JS Shambrook
Author: N. Curzen ORCID iD
Author: John M. Morgan

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