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. 2018 Jun;41(6):837-842.
doi: 10.1002/clc.22966. Epub 2018 Jun 12.

Electrocardiography scar quantification correlates with scar size of hypertrophic cardiomyopathy seen by multidetector computed tomography

Tiago Costa Bignoto  1 , Dalmo Antônio Ribeiro Moreira  1 , Ricardo Garbe Habib  1 , Edileide de Barros Correia  1 , Ricardo Carneiro Amarante  1 , Tannas Jatene  1 , Mario Barbosa Guedes Nunes  1 , Tiago Senra  1 , Luiz Eduardo Mastrocolla  1
Affiliations

Electrocardiography scar quantification correlates with scar size of hypertrophic cardiomyopathy seen by multidetector computed tomography

Tiago Costa Bignoto et al. Clin Cardiol. 2018 Jun.

Abstract

Background: Hypertrophic cardiomyopathy (HCM), a genetically transmitted disease, is the most common genetic cardiovascular disease. Current strategies to stratify risk are expensive and concentrated in wealthy centers. Twelve-lead electrocardiography (ECG) is inexpensive, universally available, and can be readily used for Selvester QRS scoring, which estimates scar size. This study aimed to establish the relation between ECG scar quantification and myocardial fibrosis (extent of myocardial delayed enhancement) in multidetector computed tomography (MDCT).

Hypothesis: There is a significant association between ECG scar quantification and the extent of myocardial delayed enhancement in MDCT.

Methods: Seventy-five patients with HCM underwent a routine clinical evaluation and echocardiography, 12-lead ECG, and MDCT study. Patients with and without an implantable cardioverter-defibrillator were included.

Results: The estimated Selvester QRS score of myocardial fibrosis was correlated significantly (R = 0.70; P < 0.01) with the quantified MDCT fibrosis. Compared with MDCT, the QRS score had 84.8% sensitivity and 88.8% specificity. Myocardial fibrosis was present in 88% of these patients with HCM (fibrotic mass, 9.87 ±10.8 g) comprising 5.66% ±6.16% of the total myocardial mass seen on the MDCT images. The Selvester QRS score reliably predicted the fibrotic mass in 76% of patients, which estimated 8.44% ±7.39% of the total myocardial mass.

Conclusions: The Selvester QRS score provides reliable quantification of myocardial fibrosis and was well correlated with MDCT in patients with HCM.

Keywords: Hypertrophic Cardiomyopathy; MDCT; Myocardial Delayed Enhancement; Myocardial Fibrosis; Selvester QRS Score.

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Conflict of interest statement

The authors declare no potential conflicts of interest.

Figures

Figure 1
Figure 1
Continuous correlation between the Selvester QRS score percentage of fibrosis and delayed enhanced MDCT percentage of fibrosis. The data show a moderate correlation (R = 0.7). Abbreviations: MDCT, multidetector computer tomography
Figure 2
Figure 2
An example of an ECG. A patient with no confounders and a score of 1 (1 QRS point in lead aVF), estimating 3% LV scarring (each QRS point represents 3% of fibrosis). The left side shows tomographic images for the same patient with fibrosis signaled. The complete Selvester QRS score criteria are in the Supporting Information, Appendices, in the online version of this article. Abbreviations: ECG, electrocardiogram; LV, left ventricular
See this image and copyright information in PMC

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