Sofia Åkerlund1, Björn Wieslander2, Madeleine Turesson1, Robin Nijveldt3, Igor Klem4, Jakob Almer5, Henrik Engblom5, Galen S Wagner6, Brett D Atwater4, Martin Ugander7. 1. Department of Clinical Physiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Duke Clinical Research Institute, Durham, NC, USA. 2. Department of Clinical Physiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden. 3. Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands. 4. Division of Cardiology, Duke University Medical Center, Durham, NC, USA. 5. Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital and Lund University, Lund, Sweden. 6. Duke Clinical Research Institute, Durham, NC, USA. 7. Department of Clinical Physiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden. Electronic address: martin.ugander@gmail.com.
Abstract
BACKGROUND: The Selvester QRS score consists of a set of electrocardiographic criteria designed to identify, quantify and localize scar in the left ventricle using the morphology of the QRS complex. These criteria were updated in 2009 to expand their use to patients with underlying conduction abnormalities, but these versions have thus far only been validated in small and carefully selected populations. AIM: To determine the specificity for each of the criteria of the left bundle branch block (LBBB) modified Selvester QRS Score (LB-SS) in a population with strict LBBB and no myocardial scar as verified by cardiovascular magnetic resonance imaging with late gadolinium enhancement (CMR-LGE). METHODS: We identified ninety-nine patients with LBBB without scar on CMR-LGE, who underwent a clinically indicated CMR scan at three different centers. The ECG recording date was any time prior to or <30days after the CMR scan. The LB-SS was applied and specificity for detection of scar in each of the 46 separate criteria was determined. RESULTS: The specificity ranged between 41% and 100% for the 46 criteria of LB-SS and 27/46 (59%) met ≥95% specificity. The mean±SD specificity was 90%±14%. CONCLUSION: Several of the criteria in the LB-SS lack adequate specificity. Elimination or modification of these nonspecific QRS morphology criteria may improve the specificity of the overall LB-SS.
BACKGROUND: The Selvester QRS score consists of a set of electrocardiographic criteria designed to identify, quantify and localize scar in the left ventricle using the morphology of the QRS complex. These criteria were updated in 2009 to expand their use to patients with underlying conduction abnormalities, but these versions have thus far only been validated in small and carefully selected populations. AIM: To determine the specificity for each of the criteria of the left bundle branch block (LBBB) modified Selvester QRS Score (LB-SS) in a population with strict LBBB and no myocardial scar as verified by cardiovascular magnetic resonance imaging with late gadolinium enhancement (CMR-LGE). METHODS: We identified ninety-nine patients with LBBB without scar on CMR-LGE, who underwent a clinically indicated CMR scan at three different centers. The ECG recording date was any time prior to or <30days after the CMR scan. The LB-SS was applied and specificity for detection of scar in each of the 46 separate criteria was determined. RESULTS: The specificity ranged between 41% and 100% for the 46 criteria of LB-SS and 27/46 (59%) met ≥95% specificity. The mean±SD specificity was 90%±14%. CONCLUSION: Several of the criteria in the LB-SS lack adequate specificity. Elimination or modification of these nonspecific QRS morphology criteria may improve the specificity of the overall LB-SS.
Authors: Zak Loring; Brett D Atwater; Xiaojuan Xia; Jimmy Axelsson; Igor Klem; Robin Nijveldt; Erik B Schelbert; Jean-Philippe Couderc; David G Strauss; Martin Ugander; Björn Wieslander Journal: J Cardiovasc Electrophysiol Date: 2019-02-19
Authors: Uzma Chaudhry; Pyotr G Platonov; Robert Jablonowski; Jean-Philippe Couderc; Henrik Engblom; Xiajuang Xia; Björn Wieslander; Brett D Atwater; David G Strauss; Jesper Van der Pals; Martin Ugander; Marcus Carlsson; Rasmus Borgquist Journal: Ann Noninvasive Electrocardiol Date: 2017-03-01 Impact factor: 1.468