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The ability of the electrocardiogram in left bundle branch block to detect myocardial scar determined by cardiovascular magnetic resonance

Wieslander, Björn; Xia, Xiaojuan; Jablonowski, Robert LU ; Axelsson, Jimmy; Klem, Igor; Nijveldt, Robin; Maynard, Charles; Schelbert, Erik B.; Sörensson, Peder and Sigfridsson, Andreas, et al. (2018) In Journal of Electrocardiology 51(5). p.779-786
Abstract

Aims: We aimed to improve the electrocardiographic 2009 left bundle branch block (LBBB) Selvester QRS score (2009 LBSS) for scar assessment. Methods: We retrospectively identified 325 LBBB patients with available ECG and cardiovascular magnetic resonance imaging (CMR) with late gadolinium enhancement from four centers (142 [44%] with CMR scar). Forty-four semi-automatically measured ECG variables pre-selected based on the 2009 LBSS yielded one multivariable model for scar detection and another for scar quantification. Results: The 2009 LBSS achieved an area under the curve (AUC) of 0.60 (95% confidence interval 0.54–0.66) for scar detection, and R2 = 0.04, p < 0.001, for scar quantification. Multivariable modeling improved... (More)

Aims: We aimed to improve the electrocardiographic 2009 left bundle branch block (LBBB) Selvester QRS score (2009 LBSS) for scar assessment. Methods: We retrospectively identified 325 LBBB patients with available ECG and cardiovascular magnetic resonance imaging (CMR) with late gadolinium enhancement from four centers (142 [44%] with CMR scar). Forty-four semi-automatically measured ECG variables pre-selected based on the 2009 LBSS yielded one multivariable model for scar detection and another for scar quantification. Results: The 2009 LBSS achieved an area under the curve (AUC) of 0.60 (95% confidence interval 0.54–0.66) for scar detection, and R2 = 0.04, p < 0.001, for scar quantification. Multivariable modeling improved scar detection to AUC 0.72 (0.66–0.77) and scar quantification to R2 = 0.21, p < 0.001. Conclusions: The 2009 LBSS detects and quantifies myocardial scar with poor accuracy. Improved models with extensive comparison of ECG and CMR had modest performance, indicating limited room for improvement of the 2009 LBSS.

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Contribution to journal
publication status
published
subject
keywords
Cardiovascular magnetic resonance, Electrocardiography, Left bundle branch block, Myocardial scar, Selvester QRS score
in
Journal of Electrocardiology
volume
51
issue
5
pages
8 pages
publisher
Elsevier
external identifiers
  • scopus:85049538651
ISSN
0022-0736
DOI
10.1016/j.jelectrocard.2018.05.019
language
English
LU publication?
yes
id
1c341a1e-aee8-4ebc-ab3f-e9083a54b21f
date added to LUP
2018-07-20 09:32:53
date last changed
2019-03-03 05:03:46
@article{1c341a1e-aee8-4ebc-ab3f-e9083a54b21f,
  abstract     = {<p>Aims: We aimed to improve the electrocardiographic 2009 left bundle branch block (LBBB) Selvester QRS score (2009 LBSS) for scar assessment. Methods: We retrospectively identified 325 LBBB patients with available ECG and cardiovascular magnetic resonance imaging (CMR) with late gadolinium enhancement from four centers (142 [44%] with CMR scar). Forty-four semi-automatically measured ECG variables pre-selected based on the 2009 LBSS yielded one multivariable model for scar detection and another for scar quantification. Results: The 2009 LBSS achieved an area under the curve (AUC) of 0.60 (95% confidence interval 0.54–0.66) for scar detection, and R<sup>2</sup> = 0.04, p &lt; 0.001, for scar quantification. Multivariable modeling improved scar detection to AUC 0.72 (0.66–0.77) and scar quantification to R<sup>2</sup> = 0.21, p &lt; 0.001. Conclusions: The 2009 LBSS detects and quantifies myocardial scar with poor accuracy. Improved models with extensive comparison of ECG and CMR had modest performance, indicating limited room for improvement of the 2009 LBSS.</p>},
  author       = {Wieslander, Björn and Xia, Xiaojuan and Jablonowski, Robert and Axelsson, Jimmy and Klem, Igor and Nijveldt, Robin and Maynard, Charles and Schelbert, Erik B. and Sörensson, Peder and Sigfridsson, Andreas and Chaudhry, Uzma and Platonov, Pyotr G. and Borgquist, Rasmus and Engblom, Henrik and Couderc, Jean Philippe and Strauss, David G. and Atwater, Brett D. and Ugander, Martin},
  issn         = {0022-0736},
  keyword      = {Cardiovascular magnetic resonance,Electrocardiography,Left bundle branch block,Myocardial scar,Selvester QRS score},
  language     = {eng},
  month        = {09},
  number       = {5},
  pages        = {779--786},
  publisher    = {Elsevier},
  series       = {Journal of Electrocardiology},
  title        = {The ability of the electrocardiogram in left bundle branch block to detect myocardial scar determined by cardiovascular magnetic resonance},
  url          = {http://dx.doi.org/10.1016/j.jelectrocard.2018.05.019},
  volume       = {51},
  year         = {2018},
}