Selvester QRS Score Research Articles

The relationship between Selvester QRS score and myocardial performance index in patients with STEMI treated by primary percutaneous coronary intervention

The relationship between Selvester QRS score and myocardial performance index in patients with STEMI treated by primary percutaneous coronary intervention

Simplified Selvester QRS Score as an Infarct Size Parameter in STEMI Patients Undergoing Pharmacoinvasive or Primary Percutaneous Coronary Intervention

Background:Cardiovascular disease especially acute myocardial infarct (AMI) is one of the highest cause of mortality worldwide. Majority of AMI comes in the form of ST elevation myocardial infarct (STEMI) that requires timely diagnosis and revascularization management to restore myocardial circulation. The simple method to estimate infarct size is by using simplified Selvester QRS Score to electrocardiogram records, which is a tested method that have good correlation with gold standard, namely cardiac magnetic resonance imaging. 
 Objectives : To investigate difference of infarct size with simplified Selvester QRS score parameter between STEMI patients undergoing pharmacoinvasive compared to primary PCI.
 Methods: Eighty-two STEMI patients, 41 of pharmacoinvasive and 41 of primary PCI was scored with simplified Selvester QRS score from electrocardiogram recording. Patient data are retroactively taken form Sardjito Cardiovascular Intensive Care (SCIENCE) registry. Scoring of simplified Selvester QRS Score was done by two experienced cardiologist blinded to patient procedure, and results then measured for interobserver agreement with Bland-Altman test. Comparison of QRS Score in pharmacoinvasive and primary PCI group was done with independent sample T test followed with multivariable linear regression test.
 Results: The means of simplified Selvester QRS score in pharmacoinvasive and primary PCI group is 7.240±3.015 and 8.900±4.188, p=0.043, respectively. Independent sample T test shows significant difference in the simplified Selvester QRS score in pharmacoinvasive and primary PCI group. The multivariable analysis shows that variables other than revascularization method independently influences QRS score are onset, anterior segment ST elevation and ST segment elevation in more > 3 leads in electrocardiogram.
 Conclusion: There is significant difference in infarct size measured by simplified Selvester QRS score betweem STEMI patient undergoing pharmacoinvasive method compared to primary PCI procedure, which is lower in the pharmacoinvasive group

Selvester QRS Score is a Predictor of Mortality in Heart Failure with Preserved Ejection Fraction.

The Selvester QRS (S-QRS) score on a 12-lead electrocardiogram (ECG) is associated with both the amount of myocardial scar and poor prognosis in myocardial infarction patients. However, its prognostic value in heart failure (HF) with preserved ejection fraction (HFpEF) is unknown. This study aims to investigate the predictive value of the S-QRS score for mortality in HFpEF. 359 patients were retrospectively enrolled in this study. Electrocardiographic, echocardiographic, and laboratory features of the patients were recorded. The simplified S-QRS score was measured and recorded. The mean follow-up time of the patients was 38.1±9.5 months. Statistical significance was set at p < 0.05. Of 359 patients, 270 were in the survivor group, and 89 were in the deceased group. Age, Hs-CRP, troponin, pro-BNP, left atrial (LA) diameter, LA volume index, QRS duration, Tpe, and S-QRS score were statistically high in the deceased group. In multivariate logistic regression analysis, age, Hs-CRP, NT-proBNP, LA diameter, LA volume index, Tpe, and S-QRS score were shown to be independent risk factors for mortality. In the receiver-operating characteristic (ROC) analysis, the cut-off value of the S-QRS score was 5.5, the sensitivity was 80.8%, and the specificity was 77.2% (AUC:0.880, p:0.00). In Kaplan-Meier analysis, it was found that mortality was higher in the group with S-QRS score ≥ 5.5 than in the group with S-QRS score < 5.5. (Long-rank, p:0.00). We think that the S-QRS score can be used as a prognostic indicator of long-term mortality in patients with HFpEF.

Effect of myocardial scar size on the risk of ventricular arrhythmias in patients with chronic total coronary occlusion

BackgroundThe presence of an untreated chronic total coronary occlusion (CTO) is associated with a higher risk of ventricular arrhythmias (VAs). This increased risk may be modulated by the presence of an existing scar. ObjectivesTo evaluate whether scar size is associated with VA in patients with an implantable cardioverter-defibrillator (ICD) and a CTO. MethodsIn this retrospective study we included patients with a CTO that received an ICD between 2005 and 2015. Scar size was estimated using the Selvester QRS score on a baseline 12‑lead ECG. The primary endpoint was any appropriate ICD therapy. ResultsOur study population comprised 148 CTO patients with a median scar size at baseline of 18% (IQR, 9–27%). Patients with a scar size ≥18% more often had a CTO located in the left anterior descending artery and a higher proportion of poor left ventricular function (<35%) and infarct-related CTO compared to patients with a smaller scar size (<18%). During a median follow-up of 35 months (interquartile range [IQR], 8–60 months), 42 patients (28%) received appropriate ICD therapy. The cumulative 5-year event rate was higher in the patients with a large scar in comparison to those with a smaller or no scar (36% versus 19%, P = 0.04). Multivariable Cox regression analysis demonstrated that large scar and diabetes mellitus were independent factors associated with appropriate ICD therapy. ConclusionIn ICD recipients with an untreated CTO, a larger scar is an independent factor associated with an increased risk of VA.

Effect of infarct size on the risk of ventricular arrhythmias in patients with chronic total coronary occlusion

Abstract Funding Acknowledgements Type of funding sources: None. Background The presence of an untreated chronic total coronary occlusion (CTO) is associated with a higher risk of ventricular arrhythmias (VAs). This increased risk may be modulated by the presence of existing scar. We hypothesize that a larger scar size is associated with a higher risk of VA. Objectives To evaluate whether infarct size is associated with VA in patients with an implantable cardioverter-defibrillator (ICD) and an untreated CTO. Methods In this retrospective study we included patients with an untreated CTO that received an ICD between 2005 and 2014. Infarct size was estimated using the Selvester QRS score on a baseline 12-lead ECG. The primary endpoint was any appropriate ICD therapy. Results Our study population comprised 148 patients (mean age at implantation 64 ± 10 years, 87% men) with an ICD and an untreated CTO. The median infarct size at baseline was 18% (IQR, 9-27%). Patients with a larger scar size (≥18%) more often had a CTO location in the LAD, higher proportion of LVEF &amp;lt;35%, and less hypertension and hypercholesterolemia compared to patients with a smaller infarct size (&amp;lt;18%). During a median follow-up of 35 months (interquartile range [IQR], 8-60 months), 42 patients (28%) received appropriate ICD therapy. The cumulative 5-year event rate was higher in the patients with a large infarct size (≥18%) in comparison to those with a smaller infarct size (&amp;lt;18%) (36% versus 19%, logrank P = 0.038, Figure). Multivariable Cox regression analysis demonstrated that a larger infarct size (≥18%) and a secondary prevention indication were independent factors associated with appropriate ICD therapy. The adjusted hazard ratio of large infarct size (≥18%) for appropriate ICD therapy was 2.34 (95% CI 1.20-4.58, p=0.01). Conclusion In ICD recipients with an untreated CTO, a larger scar size is an independent factor associated with an increased risk of VA.

Selvester score and myocardial performance index in acute anterior myocardial infarction.

The simplified Selvester QRS score is a parameter for estimating myocardial damage in ST-elevation myocardial infarction. ST-elevation myocardial infarction leads to varying degrees of impairment in left ventricular systolic and diastolic function. Myocardial performance index is a single parameter that can predict combined left ventricular systolic and diastolic performance. We investigated the relationship between Selvester score and myocardial performance index in patients undergoing primary percutaneous coronary intervention for acute anterior myocardial infarction. The study included 58 patients who underwent primary percutaneous coronary intervention for acute anterior myocardial infarction. Selvester score of all patients was also calculated at 72 h. Patients were categorized into two groups according to the Selvester score. Those with a score <6 (low score) were considered group 1 and those with a score ≥6 (high score) were considered group 2. When compared with group 1, patients in group 2 were older (p=0.01) and had lower left ventricular ejection fractions (50.3±4 vs. 35.6±6.9, p=0.001), and conventional myocardial performance index (0.52±0.06 vs. 0.69±0.08, p=0.001), lateral tissue Doppler-derived myocardial performance index (0.57±0.08 vs. 0.72±0.08, p=0.001), and septal tissue Doppler-derived myocardial performance index (0.62±0.07 vs. 0.76±0.08, p=0.001) were higher. There was a high correlation between lateral tissue Doppler-derived myocardial performance index and conventional myocardial performance index and Selvester score (r=0.80, p<0.001; r=0.86, p<0.001, respectively) and a moderate correlation between septal tissue Doppler-derived myocardial performance index and Selvester score (r=0.67, p<0.001). The post-procedural Selvester score can predict lateral tissue Doppler-derived myocardial performance index and conventional myocardial performance index with high sensitivity and acceptable specificity in patients undergoing primary percutaneous coronary intervention for acute anterior myocardial infarction.

Age, GFR, and Ejection Fraction Score as a Good Predictor of Prognosis in Elderly Patients with Nonischemic Dilated Cardiomyopathy

Introduction: Nonischemic dilated cardiomyopathy (NIDCM) is a heterogeneous disease, and patients still have high risk of sudden cardiac death even after receiving treatment. The Selvester QRS score and the ESTIMATED score reported as predictors contain many variables and are complex to calculate. There is a need for a simple predictive score to accurately assess prognosis in clinical practice. Methods: A total of 953 elderly patients (age ≥60 years) diagnosed with NIDCM were enrolled from January 2010 to December 2019. In-hospital and long-term outcomes were studied. Results: Univariate logistic regression analysis showed that the AGEF score was associated with in-hospital mortality (OR: 1.828; 95% CI: 1.559–2.144; p < 0.001). Receiver operator characteristic curve analysis showed that the AGEF score was excellent at predicting clinical outcomes. The optimal cutoff value of the AGEF score for predicting long-term mortality was 2.50 (AUC = 0.743; 95% CI: 0.710–0.776; p < 0.001). Kaplan-Meier survival analysis showed that patients with an AGEF score >2.50 had a worse prognosis than those with an AGEF score ≤2.50 (log-rank χ2 103.69, p < 0.001). Moreover, multivariate Cox proportional hazard analysis showed that an AGEF score ≤2.50 was associated with a lower risk of long-term mortality in elderly patients with NIDCM (HR: 0.405; 95% CI: 0.310–0.529; p < 0.001). Conclusions: The AGEF score could be considered as a simple and useful tool for risk stratification in elderly patients with NIDCM.

Prediction of Successful Reperfusion in ST-Elevation Myocardial Infarction Patients Following Thrombolytic Treatment or Primary PCI Using Modified Selvester QRS Score

Prediction of Successful Reperfusion in ST-Elevation Myocardial Infarction Patients Following Thrombolytic Treatment or Primary PCI Using Modified Selvester QRS Score

Selvester QRS score predicts improvement of LVEF in atrial fibrillation patients with systolic heart failure.

Left-ventricular systolic dysfunction (LVSD) comorbid with atrial fibrillation is reversible, but recovery is limited in a subset of patients. The Selvester QRS (S-QRS) score is an electrocardiogram-based assessment that reportedly reflects myocardial scar/damage. We evaluated the predictability of S-QRS score for the recovery of left-ventricular ejection fraction (LVEF) in persistent AF (PeAF) patients with LVSD undergoing catheter ablation (CA). CA was performed in 51 PeAF patients with reduced LVEF (<40%); S-QRS scores were measured after restoration of sinus rhythm. LVEF was re-evaluated at one year after CA; LVEF recovery was related to the S-QRS score. The median [interquartile range] S-QRS score was 1 point [0-2]. LVEF increased from 32% [28-37] at baseline to 56% [49-57] at 1 year after CA. Thirty-seven patients achieved normalization of LVEF (≥50%, Group A); 14 patients did not (Group B). Group A had significantly lower S-QRS scores than Group B (0 point [0-2] vs. 2 points [2-3], p<.05). In univariate/multivariate analyses, S-QRS score was an independent predictor of LVEF normalization. In the receiver operating characteristic curve, the cut-off value of S-QRS score was 2 points for prediction of the LVEF normalization (AUC=0.79). Patients with low S-QRS score (<2 points) had greater LVEF improvement than those with high S-QRS score (≥2 points, ΔLVEF: 23% [17-28] vs. 17% [12-24], p<.05). S-QRS scoring noninvasively assesses the improvement of LVEF in PeAF patients with LVSD after CA. A high S-QRS score may indicate underlying myocardial scar/damage associated with unknown etiologies for LVSD other than PeAF.

Predictive value of Selvester QRS score for severity of coronary artery disease in ST-segment elevation myocardial infarction

Kontext: Je známo, že skóre QRS je spolehlivým prediktorem rozsahu infarktu a nepříznivé prognózy pacientů po infarktu myokardu s elevacemi úseku ST (ST-segment elevation myocardial infarction, STEMI). Cíl: Naším cílem bylo definovat vztah mezi skórovacími systémy skóre SYNTAX II (SS-II) a skóre QRS u pa- cientů po STEMI. Metody: Do studie bylo zařazeno 302 po sobě následujících pacientů (71,8 % mužů, průměrný věk 55,1 &#177; 12,2 roku) po STEMI, léčených primární perkutánní koronární intervencí (percutenous coronary intervention, PCI). Pacienti byli rozděleni do dvou skupin podle hodnot SS-II (jedinci s SS-II &#8804; 32 tvořili skupinu s "nízkým" skóre [n = 241], zatímco jedinci s SS-II &gt; 32 představovali skupinu se "středně vysokým až vysokým" skóre [n = 61]). Výsledky: Pacienti se "středně vysokým až vysokým" skóre byli starší. Hodnoty N-terminálního fragmentu natriuretického propeptidu typu B (NT-pro brain natriuretic peptide, NT-proBNP), troponinu, indexu skóre kinetiky srdeční stěny a perfuze myokardu měřená metodou TIMI frame count byly statisticky významně vyšší ve skupině se "středně vysokým až vysokým" SS-II než ve druhé skupině (p &lt; 0,05 pro všechny hodnoty). U pacientů ve skupině se "středně vysokým až vysokým" SS-II byla zjištěna nízká ejekční frakce (p &lt; 0,001). Hodnoty souhrnného sledovaného parametru byly statisticky významně vyšší ve skupině se "středně vysokým až vysokým" SS-II (p = 0,01). Selvesterovo skóre QRS bylo statisticky významně vyšší ve skupině se "středně vysokým až vysokým" SS-II než ve skupině s "nízkým" SS-II (p &lt; 0,001). Bylo prokázáno, že skóre QRS, hypertenze, kuřáctví a hodnoty TIMI frame count představují nezávislé prediktory SS-II. Mezní hodnota skóre QRS predikující hodnotu SS-II na základě analýzy křivky ROC byla 9,0 při senzitivitě 50,9 % a specificitě 84,1 % (AUC 0,726; 95% CI 0,648-0,804; p &lt; 0,001). Závěr: Skóre QRS je spojeno se skóre SS-II predikujícím závažnost ischemické choroby srdeční a mortalitu pacientů se STEMI, u nichž byla provedena primární PCI. &#169; 2021, ČKS.

Reperfusion After Fibrinolytic Therapy (RAFT): An open-label, multi-centre, randomised controlled trial of bivalirudin versus heparin in rescue percutaneous coronary intervention.

BackgroundThe safety and efficacy profile of bivalirudin has not been examined in a randomised controlled trial of patients undergoing rescue PCI.ObjectivesWe conducted an open-label, multi-centre, randomised controlled trial to compare bivalirudin with heparin ± glycoprotein IIb/IIIa inhibitors (GPIs) in patients undergoing rescue PCI.MethodsBetween 2010–2015, we randomly assigned 83 patients undergoing rescue PCI to bivalirudin (n = 42) or heparin ± GPIs (n = 41). The primary safety endpoint was any ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) bleeding at 90 days. The primary efficacy endpoint was infarct size measured by peak troponin levels as a multiple of the local upper reference limit (Tn/URL). Secondary endpoints included periprocedural change in haemoglobin adjusted for red cells transfused, TIMI (Thrombolysis in Myocardial Infarction) bleeding, ST-segment recovery and infarct size determined by the Selvester QRS score.ResultsThe trial was terminated due to slow recruitment and futility after an interim analysis of 83 patients. The primary safety endpoint occurred in 6 (14%) patients in the bivalirudin group (4.8% GPIs) and 3 (7.3%) in the heparin ± GPIs group (54% GPIs) (risk ratio, 1.95, 95% confidence interval [CI], 0.52–7.3, P = 0.48). Infarct size was similar between the two groups (mean Tn/URL, 730 [±675] for bivalirudin, versus 984 [±1585] for heparin ± GPIs, difference, 254, 95% CI, -283-794, P = 0.86). There was a smaller decrease in the periprocedural haemoglobin level with bivalirudin than heparin ± GPIs (-7.5% [±15] versus -14% [±17], difference, -6.5%, 95% CI, -0.83–14, P = 0.0067). The rate of complete (≥70%) ST-segment recovery post-PCI was higher in patients randomised to heparin ± GPIs compared with bivalirudin.ConclusionsWhether bivalirudin compared with heparin ± GPI reduces bleeding in rescue PCI could not be determined. Slow recruitment and futility in the context of lower-than-expected bleeding event rates led to the termination of this trial (ANZCTR.org.au, ACTRN12610000152022).

Predictive role of Frontal QRS-T angle and Selvester QRS Score in determining angiographic slow flow phenomenon following percutaneous coronary intervention in patients with Non-ST elevation myocardial infarction

AimSlow flow (SF) that develops after percutaneous coronary intervention (PCI) is significantly associated with poor prognosis in Non-ST elevation myocardial infarction (Non-STEMI) patients. Increased Selvester QRS score and Frontal QRS-T angle [f(QRS-T)] are related to adverse cardiovascular outcomes. We aimed to investigate the predictive role of the Selvester QRS score and f(QRS-T) for the development of post-PCI SF in patients with Non-STEMI. Method and resultsIn a retrospective study, 210 patients with Non-STEMI were divided into two groups as SF (29) and Non-SF (181) according to their TIMI coronary flow grade. For all patients the Selvester QRS score and f(QRS-T) were calculated from automatic electrocardiography (ECG) reports. The mean age of the study population was 63 (55‐75) years and 102 (68.6%) of patients were male. The Selvester QRS score and f(QRS-T) were higher in the SF group than in the Non-SF group [(5[3–8], 3[2–5]); (67° [42°–88°], 39° [24°–59°]), respectively, all p <0.01]. In a logistic regression analysis, the Selvester QRS score (OR = 4,862; 95% (CI) = 1,131-20,904, p =0.03) and f(QRS-T) (OR = 5,489; 95% (CI)= 11,433-21,034, p =0.01) were found independent predictors of post-PCI SF in Non-STEMI patients. Receiver operating characteristic (ROC) analysis was performed to assess the diagnostic values of the Selvester QRS score [86% sensitivity; 44% specificity; cut off 2; (AUC, 0.693)] and f(QRS-T) [62% sensitivity; 73% specificity; cut off 58°; (AUC, 0.778)]. ConclusionThe Selvester QRS score and f(QRS-T), both easy-to-calculate ECG parameters, are predictors of post-PCI SF in Non-STEMI patients.

QRS score: A simple marker to quantify the extent of myocardial scarring in patients with chronic total arterial occlusion

BackgroundChronic total occlusion (CTO) is a critical and unique subgroup of coronary lesions. This study aimed to investigate the correlation between the Selvester QRS score and late gadolinium enhancement cardiac magnetic resonance imaging (LGE-CMRI) in quantifying myocardial scarring to provide a simple and feasible method for treating CTO. MethodsThe medical records of 134 patients with absolute CTO who underwent coronary angiography between May 1, 2014 and December 30, 2017 were retrospectively reviewed. All patients were grouped according to the CTO location (RCA CTO, LAD CTO, LCX CTO, and multi-vessel CTO groups). The degree of myocardial scarring was determined according to the Selvester QRS score and using the LGE-CMRI. All patients were followed up for at least 12 months. ResultsAmong the 62 CTO patients, 55 had occlusion of a single vessel and seven had occlusion of multiple vessels, of which 27 (43.55%) were in the RCA CTO group, 16 (25.81%) in the LAD CTO group, 12 (19.35%) in the LCX CTO group, and 7 (11.29%) in the multi-vessel CTO group. The area under the receiver operating characteristic curve for the QRS score that was used to determine the degree of myocardial scarring was 0.806, with a sensitivity and specificity of 94.7% and 42.1%, respectively. The Selvester QRS score and LGE-CMRI measures of scar size were correlated in the RCA CTO, LCX CTO, and multi-vessel CTO groups (r = 0.466, 0.593, and 0.775, respectively). ConclusionThe Selvester QRS score was feasible for detecting myocardial scarring in patients with CTO.

The Selvester QRS score as an estimative of myocardial injury in acute chagasic patients from the Brazilian Amazon

BackgroundIn the Brazilian Amazon, a new epidemiological profile of Chagas disease transmission, the oral route, has been detected and cited as being responsible for the increase in acute cases in Brazil. The clinical evaluation of acute Chagas disease (ACD) has been a challenge since it can progress to a chronic phase with cardiac alterations, and the follow-up by modern diagnostic methods is very difficult due to the socio-geographical characteristics of the Brazilian Amazon. Thus, alternatives should be sought to alleviate this problem. We conducted a study to evaluate subjects with ACD using the 12-lead ECG QRS score (Selvester score) as an estimative of myocardial injury progression before and after ACD treatment.MethodsThe study included indigenous subjects from the Amazon region with ACD in clinical follow-up at the Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD) Chagas Disease outpatient clinic in the state of Amazonas, Brazil. The control group consisted of 31 healthy volunteers with no history of heart disease and no reactive serology for Chagas disease. Baseline ECG was performed in all subjects. The Selvester scoring method was performed according to the standardized guide (< 3 points: no myocardial injury,> 3: points × 3% = % of the predicted LV infarction).ResultsA total of 62 subjects were included, 31 as cases and 31 as controls. The mean follow-up of the case group was 17 months. The control group presented normal ECG. The case group presented 13 alterations before treatment and 11 after. Nineteen individuals presented scores > 3 points, 6 before and 13 after. In 19.36% of subjects, myocardial injury was found before treatment and in 41.94% after treatment.ConclusionThis is the first study that uses the Selvester score (SS) to predict myocardial injury in subjects with ACD. The results of this study suggest the significant presence of myocardial injury from the beginning of treatment to the period post treatment of ACD, which demonstrates that the SS can be applied for stratification and follow-up of Chagas disease in the Amazon region.

Prognostic value of the Selvester QRS score for re-hospitalization in patients with ischemic heart failure

Aim: The Selvester QRS score (SSc) on surface electrocardiogram (ECG) has prognostic value in various cardiac events related to myocardial scarring. Furthermore, the SSc system has been validated by post-mortem studies. In this cohort, we assessed the utility of the SSc system for prediction of re-hospitalization in patients with ischemic heart failure (HF). Methods: In this retrospective cohort study, the data of fifty-four consecutive patients with ischemic HF were analyzed. ECGs were collected at first day of admission and SScs were calculated. The primary endpoint was re-hospitalization within the first 3 months. Results: At baseline, the mean age was 62.1 years, LVEF was 29(6) %, NT-proBNP level was 2830 pg/mL. Twenty-one re-hospitalizations were observed due to HF. Patients who were re-hospitalized had significantly higher SScs than those who were not (5.6 vs.3.3 P= 0.01). Cox regression analysis demonstrated that the SSc was an independent predictor of re-hospitalization rate (HR, 1.12; 95% CI, 0.95–1.34; P=0.04). Roc curve analysis showed that SSc was predictive for rehospitalization with a cut-off value 4.3, with a sensitivity of 65% and a specificity of 49% (AUC 0.618, P=0.02). Our analysis indicated a positive correlation between SSc with NT-proBNP and a negative correlation between SSc and LVEF (respectively r=0.33, P=0.03 and r =-0.67, P=0.04). Conclusion: Our results suggest that baseline SSc can be used as a predictor of re-hospitalization due to ischemic HF.

Predictive Role of Selvester QRS Score in Patients Undergoing Transcatheter Aortic Valve Replacement

Abstract Introduction Few data exist regarding the late clinical impact of the Selvester score prediction of myocardial fibrosis after transcatheter aortic valve replacement (TAVR). This study evaluated the predictive power of the Selvester score on survival in patients with aortic stenosis (AS) undergoing TAVR. Methods and results Patients with severe AS who had preoperative electrocardiograms were included. Clinical follow-up was obtained retrospectively. The primary endpoint was all-cause mortality. Secondary endpoints were cardiovascular death and major adverse cardiac events (MACE). Two hundred twenty-eight patients were included (mean age, 81.5±7.4 years; women, 58.3%). Deceased patients had a higher mean score (4.6±3.2 vs. 1.4±1.3; p&amp;lt;0.001). At a mean follow-up of 36.2±21.2 months, the Selvester score was independently associated with all-cause mortality (hazard ratio [HR], 1.65; 95% confidence interval [CI], 1.48–1.84; p&amp;lt;0.001), cardiovascular death (HR, 1.59; 95% CI, 1.38–1.74; p&amp;lt;0.001), and MACE (HR, 1.55; 95% CI, 1.30–1.68; p&amp;lt;0.001). After 5 years, the mortality risk was incrementally related to the Selvester score. The involvement of the inferior wall of the left ventricle was a lower mortality risk (HR, 0.42; 95% CI, 0.18 to 0.98; p=0.046). For a Selvester score of 3, the area under the curve showed 0.92, 0.94, and 0.86 (p&amp;lt;0.001), respectively, for 1, 2, and 3 years. Conclusions Elevated Selvester scores increase the risk of poor outcomes in patients with AS undergoing TAVR. The involvement of the anterior or lateral wall presents worse prognosis. Kaplain Meier and ROC Curve Funding Acknowledgement Type of funding source: None

Automated electrocardiographic quantification of myocardial scar in patients undergoing primary prevention implantable cardioverter-defibrillator implantation: Association with mortality and subsequent appropriate and inappropriate therapies

Myocardial scarring from infarction or nonischemic fibrosis forms an arrhythmogenic substrate. The Selvester QRS score has been developed to estimate myocardial scar from the 12-lead electrocardiogram. We aimed to assess the value of an automated version of the Selvester QRS score for the prediction of implantable cardioverter-defibrillator (ICD) therapy and death in patients undergoing primary prevention ICD implantation. Unselected patients undergoing primary prevention ICD implantation were included in this retrospective, observational, multicenter study. The QRS score was calculated automatically from a digital standard preimplantation 12-lead electrocardiogram and was correlated to the occurrence of death and appropriate and inappropriate shocks during follow-up. Analyses were performed in groups defined by QRS duration < 130 ms vs ≥ 130 ms. Overall, 1047 patients (872 [83%] men; median age 64 years IQR [55-71]) with ischemic (648, 62%) or nonischemic (399, 38%) cardiomyopathy were included. The median QRS duration was 123 ms (interquartile range [IQR] 111-157 ms), and the median QRS score was 5 (IQR 2-8). The QRS duration was <130 ms in 59% and ≥130 ms in 41%. During a median follow-up of 45 months (IQR 24-72 months), a QRS score of ≥5 was independently associated with a significantly higher risk of mortality (hazard ratio [HR] 1.67; 95% confidence interval [CI] 1.05-2.66; P = .031) and appropriate (HR 1.83; 95% CI 1.07-3.14; P = .028) and inappropriate (HR 2.32; 95% CI 1.04-5.17; P= .039) shocks in patients with QRS duration ≥ 130 ms. No association of the QRS score and outcome was observed in patients with QRS duration < 130 ms (P > .05). The automatically calculated Selvester QRS score, an indicator of myocardial scar burden, predicts mortality and appropriate and inappropriate shocks in patients undergoing primary prevention ICD implantation with a prolonged QRS duration.

Performance of 12-lead electrocardiogram Selvester QRS scoring criteria to diagnose myocardial scar in patients with hypertrophic cardiomyopathy.

BackgroundThe Selvester QRS score can identify the presence and extent of myocardial scar in ischemic and nonischemic cardiomyopathy, but its performance in patients with hypertrophic cardiomyopathy (HCM) has not been assessed.MethodsConsecutive patients with HCM referred to our hospital between January 2012 and July 2016 were prospectively enrolled. All patients underwent cardiac magnetic resonance (CMR) and 12‐lead electrocardiography. The Selvester QRS score was used to evaluate the presence and extent of myocardial scarring, and the results were compared with that obtained with the gold standard—late gadolinium enhancement (LGE) on CMR.ResultsA total of 135 HCM patients were enrolled. LGE was present in 93 of 135 (69%) patients. The median LGE mass was 5 (0–14) g, and the median proportion of total left ventricular mass showing LGE was 4% (0%–10%). A total of 92 patients had Selvester score ≥1. The highest score recorded was 13; the median score was 1 (0–3). In receiver operating curve analysis, Selvester score ≥1 was identified as the optimum score for predicting presence of LGE enhancement; the area under the curve was 0.826 (95% CI, 0.752–0.900; p < .001). Significant positive correlation was seen between the Selvester score and the extent of LGE enhancement (Spearman ρ, .572; p < .001). The Selvester scoring system correctly identified all LGE segments in 13 of 93 (14%) patients and some LGE segments in 39 (41.9%) patients.ConclusionsThe Selvester QRS score appears to be a convenient and reliable method to determine the presence and extent of myocardial scar in patients with HCM.

Both baseline Selvester QRS score and change in QRS score predict prognosis in patients with acute ST-segment elevation myocardial infarction after percutaneous coronary intervention

Background:We aimed to demonstrate the prognostic value of Selvester QRS scores in patients with acute ST-segment elevation myocardial infarction (STEMI).Methods:In this prospective, observational study, we screened 289 patients with acute STEMI who underwent percutaneous coronary intervention (PCI) from 1 January 2014 to 1 June 2015 at the Second Hospital of Dalian Medical University. Selvester QRS scores were calculated at the time of hospital admission and within 24 h after treatment for PCI. The primary endpoint was the 2-year mortality rate, and the secondary endpoint was any nonfatal major adverse cardiovascular event (MACE).Results:Of the 289 patients, the QRS score increased in 115 (39.8%), and the 2-year mortality and MACE rates were significantly higher in these patients than in those in whom the QRS score decreased or remained unchanged after the treatment of PCI. Multivariable Cox regression analysis revealed that both baseline QRS scores and changes in QRS scores were independently associated with the 2-year mortality rate [hazard ratio (HR) 1.462, 95% confidence interval (95% CI) 1.279–1.671 and HR 5.122, 95% CI 2.128–12.328, respectively), MACE rate (HR 1.119, 95% CI 1.019–1.229 and HR 2.585, 95% CI 1.260–5.303, respectively) and composite endpoint (HR 1.137, 95% CI 1.047–1.236 and HR 3.152, 95% CI 1.704–5.829, respectively) after adjusting for other risk factors.Conclusion:In conclusion, both baseline Selvester QRS scores and changes in QRS scores independently predicted poor outcomes in patients with acute STEMI who underwent PCI.

Complete versus simplified Selvester QRS score for infarct severity assessment in ST-elevation myocardial infarction

BackgroundComplete and simplified Selvester QRS score have been proposed as valuable clinical tool for estimating myocardial damage in patients with ST-elevation myocardial infarction (STEMI). We sought to comprehensively compare both scoring systems for the prediction of myocardial and microvascular injury assessed by cardiac magnetic resonance (CMR) imaging in patients with acute STEMI.MethodsIn this prospective observational study, 201 revascularized STEMI patients were included. Electrocardiography was conducted at a median of 2 (interquartile range 1–4) days after the index event to evaluate the complete and simplified QRS scores. CMR was performed within 1 week and 4 months thereafter to determine acute and chronic infarct size (IS) as well as microvascular obstruction (MVO).ResultsComplete and simplified QRS score showed comparable predictive value for acute (area under the curve (AUC) = 0.64 vs. 0.67) and chronic IS (AUC = 0.63 vs. 0.68) as well as for MVO (AUC = 0.64 vs. 0.66). Peak high sensitivity cardiac troponin T (hs-cTnT) showed an AUC of 0.88 for acute IS and 0.91 for chronic IS, respectively. For the prediction of MVO, peak hs-cTnT represented an AUC of 0.81.ConclusionsIn reperfused STEMI, complete and simplified QRS score displayed comparable value for the prediction of acute and chronic myocardial as well as microvascular damage. However, both QRS scoring systems provided inferior predictive validity, compared to peak hs-cTnT, the clinical reference method for IS estimation.