Published in:
01-09-2018 | Original Paper
Automatically computed ECG algorithm for the quantification of myocardial scar and the prediction of mortality
Authors:
Patrick Badertscher, Ivo Strebel, Ursina Honegger, Nicolas Schaerli, Deborah Mueller, Christian Puelacher, Max Wagener, Roger Abächerli, Joan Walter, Zaid Sabti, Lorraine Sazgary, Stella Marbot, Jeanne du Fay de Lavallaz, Raphael Twerenbold, Jasper Boeddinghaus, Thomas Nestelberger, Nikola Kozhuharov, Tobias Breidthardt, Samyut Shrestha, Dayana Flores, Carmela Schumacher, Damian Wild, Stefan Osswald, Michael J. Zellweger, Christian Mueller, Tobias Reichlin
Published in:
Clinical Research in Cardiology
|
Issue 9/2018
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Abstract
Background
Myocardial scar is associated with adverse cardiac outcomes. The Selvester QRS-score was developed to estimate myocardial scar from the 12-lead ECG, but its manual calculation is difficult. An automatically computed QRS-score would allow identification of patients with myocardial scar and an increased risk of mortality.
Objectives
To assess the diagnostic and prognostic value of the automatically computed QRS-score.
Methods
The diagnostic value of the QRS-score computed automatically from a standard digital 12-lead was prospectively assessed in 2742 patients with suspected myocardial ischemia referred for myocardial perfusion imaging (MPI). The prognostic value of the QRS-score was then prospectively tested in 1151 consecutive patients presenting to the emergency department (ED) with suspected acute heart failure (AHF).
Results
Overall, the QRS-score was significantly higher in patients with more extensive myocardial scar: the median QRS-score was 3 (IQR 2–5), 4 (IQR 2–6), and 7 (IQR 4–10) for patients with 0, 5–20 and > 20% myocardial scar as quantified by MPI (p < 0.001 for all pairwise comparisons). A QRS-score ≥ 9 (n = 284, 10%) predicted a large scar defined as > 20% of the LV with a specificity of 91% (95% CI 90–92%). Regarding clinical outcomes in patients presenting to the ED with symptoms suggestive of AHF, mortality after 1 year was 28% in patients with a QRS-score ≥ 3 as opposed to 20% in patients with a QRS-score < 3 (p = 0.001).
Conclusions
The QRS-score can be computed automatically from the 12-lead ECG for simple, non-invasive and inexpensive detection and quantification of myocardial scar and for the prediction of mortality.