Selvester QRS Score Research Articles

An ischemic index from the electrocardiogram to select patients with low left ventricular ejection fraction for coronary artery bypass grafting

Patients who have a decreased left ventricular (LV) ejection fraction (EF) may be denied coronary bypass grafting (CABG) because it is assumed that improvement in function is unlikely. If the low LVEF were due to myocardial necrosis, this assumption would be valid. If the dysfunction were due to both necrosis and ischemia, however, then improvement may be possible with CABG. A method capable of identifying such patients would be useful. In this study, an “ischemic index” was determined for 37 patients based on the difference between the presurgical LVEF estimated from the standard 12-lead electrocardiogram by the Selvester QRS score (indicating the extent of dysfunction due to necrosis) and the presurgical LVEF measured from resting multigated radionuclide angiography (indicating dysfunction due to both necrosis and ischemia). It was hypothesized that a high ischemia index, that is, a large discrepancy between estimated and measured LVEF, would be associated with an improved postsurgical measured LVEF. The results showed that patients with an ischemic index of ≤0 had a mean decrease in LVEF of 8% (p = 0.02) and those with an index between 0 and 10 had no mean change. Patients with an index ≥11, however, had a mean increase of 5% (p = 0.02), suggesting that depressed LVEF may improve following CABG among patients whose low function is due primarily to reversible ischemia as indicated by a high ischemic index.

Prognostic value of the simplified selvester QRS score in patients with coronary artery disease

The relation of the simplified Selvester QRS scoring system for the estimation of myocardial infarct size to survival was studied in 1,915 nonsurgically treated patients with docamented coronary artery disease. Electrocardiograms (ECGs) were scored according to a simplifi d 29 point QRS scoring system. Using Cox model analyses, QRS scores were found to provide strong prognostic information by themselves (p < 0.0001). Higher QRS scores were associated with lower survival rates. Patients with a score of 0 had a 1 year survival rate of 95% and a 5 year survival rate of 88%; patients with a score of 10 or more had survival rates of 81 and 52%, respectively, at the same intervals. Directly compared with the presence or absence of Q waves on the ECG, QRS scores provided greater prognostic information (p < 0.001).When compared with 13 individual factors previously shown to provide the greatest independent prognostic information, the QRS score was the third most powerful individual prognostic factor. It did not contribute independent prognostic information in combination with the whole group, but did provide independent information in combination with the six most predictive factors. Its prognostic information overlapped mostly with clinical factors related to heart failure, and combined best with clinical factors related to the severity of ongoing myocardial ischemia. Because it is inexpensive and simple and maximizes the prognostic information from the ECG, the simplified Selvester QRS scoring system can be a useful clinical descriptor for practitioners and clinical investigators.

A comprehensive estimation of acute myocardial infarct size using enzymatic, electrocardiographic and mechanical methods

This prospective study compares the estimated size of acute myocardial infarction (AMI) by cumulative serum creatine kinase isoenzyme MB (CK-MB), Selvester QRS score, and 2-dimensional (2-D) echocardiographic dyssynergy of the left ventricle in 63 consecutive patients with their first anterior (n = 31) or inferior AMI (n = 32). The correlations among these parameters were good for patients with anterior AMI (r = 0.74 to 0.78, standard error of the estimate = 29 to 33%) but only fair for those with inferior AMI (r = 0.35 to 0.47, standard error of the estimate = 38 to 73%). Based on previous autopsy studies, estimates of CK-MB and QRS score were then converted to percent of infarcted left ventricle. Linear regression analyses between mean percent AMI size by cumulative CK-MB plus QRS score vs the number of dyssynergic segments by 2-D echocardiography were used to develop a comprehensive formula for estimating AMI size by a combination of all 3 techniques. Thus, a formula is proposed that may optimally estimate AMI size derived from leakage of cytosolic enzymes, changes in the sequence of myocardial depolarization, and irregularities of left ventricular contraction.

Relation between electrocardiographic and enzymatic methods of estimating acute myocardial infarct size

The extent of initial acute myocardial infarction (AMI) and subsequent patient prognosis were studied using 2 independent indicators of AMI size. Two inexpensive, readily available techniques, the complete Selvester QRS score from the standard 12-lead electrocardiogram and the peak value of the isoenzyme MB of creatine kinase (CK-MB), were evaluated in 125 patients with initial AMI. The overall correlation between peak CK-MB and QRS score was fair (0.57), with marked difference according to anterior (0.72) or inferior (0.35) location. The prognostic capabilities of each measurement varied. Peak CK-MB provided significant information concerning hospital morbidity or early mortality (within 30 days) for both anterior ( χ 2 = 9.83) and inferior ( χ 2 = 9.83) AMI locations; however, the QRS score was significant only for anterior AMI ( χ 2 = 9.50. For total 24-month mortality, the QRS score alone provided the most information ( χ 2 = 10.0, p = 0.0016), which was not improved with the addition of CK-MB ( χ 2 = 0.07, p = 0.79). This study shows a good relation between these 2 independent estimates of AMI size for patients with anterior AMI location. Both QRS and CK-MB results are significantly related to early morbidity and mortality; however, only the QRS score is related to total 24-month prognosis.