Myocardial Scar on Surface ECG: Selvester Score, but Not Fragmentation, Predicts Response to CRT
Purpose. Myocardial scar is directly related to the response to CRT after implantation. The extent of myocardial scar can be detected not only by cardiac magnetic resonance but also by two electrocardiographic scores: fragmented QRS (fQRS) and Selvester score (SSc). The aim of our study is to compar...
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doaj-cc41edfb28714f2f858fd0dab46230ec2020-11-25T03:58:13ZengHindawi LimitedCardiology Research and Practice2090-80162090-05972020-01-01202010.1155/2020/20365452036545Myocardial Scar on Surface ECG: Selvester Score, but Not Fragmentation, Predicts Response to CRTMartina Nesti0Alessandro Paoletti Perini1Rossella Bani2Stella Cartei3Luca Checchi4Giuseppe Ricciardi5Paolo Pieragnoli6Federica Michelotti7Giosuè Mascioli8Elena Cavarretta9Luigi Sciarra10Cardiovascular and Neurological Department, San Donato Hospital, Arezzo, ItalyCardiology and Electrophysiology Unit, Santa Maria Nuova Hospital, Florence, ItalyDepartment of Medical, Surgical and Neuro Sciences, Diagnostic Imaging, University of Siena, Siena, ItalyCardiology, San Giuseppe Hospital, Empoli, Florence, ItalyUniversity of Florence, Arrhythmic Disease Unit, Firenze, ItalyUniversity of Florence, Arrhythmic Disease Unit, Firenze, ItalyUniversity of Florence, Arrhythmic Disease Unit, Firenze, ItalyCliniche Humanitas Gavazzeni, Bergamo, ItalyCliniche Humanitas Gavazzeni, Bergamo, ItalyDepartment of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, ItalyDepartment of Cardiology, Policlinico Casilino, Rome, ItalyPurpose. Myocardial scar is directly related to the response to CRT after implantation. The extent of myocardial scar can be detected not only by cardiac magnetic resonance but also by two electrocardiographic scores: fragmented QRS (fQRS) and Selvester score (SSc). The aim of our study is to compare the role of baseline SSc and fQRS in predicting response to CRT in a cohort of heart failure patients with true left bundle branch block (LBBB). As a secondary endpoint, we assessed the association of both scores with overall and cardiac mortality, heart failure hospitalizations, ventricular arrhythmias requiring ICD intervention, and major adverse cardiovascular event (MACE). Methods. We evaluated fQRS and SSc of 178 consecutive HF patients with severe systolic dysfunction (LVEF ≤ 35%), NYHA class II-III despite optimal medical treatment, and true-LBBB. Response to CRT was defined as the improvement of LVEF of at least 10% or as the reduction of LVESV of at least 15% at a 6-month follow-up. Each endpoint was related to fQRS and SSc. Results. SSc ≥7 was significantly associated with the absence of echocardiographic response to CRT (OR: 0.327; 95% C.I. 0.155–0.689; p=0.003), while the presence of fQRS at baseline ECG was not (OR: 1.133; 95% C.I. 0.539–2.381; p=0.742). No correlation was found between SSc and overall mortality, cardiac death, ventricular arrhythmias, hospitalizations due to heart failure, or for MACE. Similar results were observed between fQRS and all secondary endpoints. Conclusion. In HF patients with true-LBBB and LVEF ≤35% eligible for CRT, myocardial scar assessed by calculating the SSc on preimplant ECG is an independent predictor of nonresponse after multiple adjustments. Neither SSc nor fQRS is associated with overall and cardiac death, ventricular arrhythmias, or hospitalization for heart failure at a 24-month follow-up.http://dx.doi.org/10.1155/2020/2036545 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Martina Nesti Alessandro Paoletti Perini Rossella Bani Stella Cartei Luca Checchi Giuseppe Ricciardi Paolo Pieragnoli Federica Michelotti Giosuè Mascioli Elena Cavarretta Luigi Sciarra |
spellingShingle |
Martina Nesti Alessandro Paoletti Perini Rossella Bani Stella Cartei Luca Checchi Giuseppe Ricciardi Paolo Pieragnoli Federica Michelotti Giosuè Mascioli Elena Cavarretta Luigi Sciarra Myocardial Scar on Surface ECG: Selvester Score, but Not Fragmentation, Predicts Response to CRT Cardiology Research and Practice |
author_facet |
Martina Nesti Alessandro Paoletti Perini Rossella Bani Stella Cartei Luca Checchi Giuseppe Ricciardi Paolo Pieragnoli Federica Michelotti Giosuè Mascioli Elena Cavarretta Luigi Sciarra |
author_sort |
Martina Nesti |
title |
Myocardial Scar on Surface ECG: Selvester Score, but Not Fragmentation, Predicts Response to CRT |
title_short |
Myocardial Scar on Surface ECG: Selvester Score, but Not Fragmentation, Predicts Response to CRT |
title_full |
Myocardial Scar on Surface ECG: Selvester Score, but Not Fragmentation, Predicts Response to CRT |
title_fullStr |
Myocardial Scar on Surface ECG: Selvester Score, but Not Fragmentation, Predicts Response to CRT |
title_full_unstemmed |
Myocardial Scar on Surface ECG: Selvester Score, but Not Fragmentation, Predicts Response to CRT |
title_sort |
myocardial scar on surface ecg: selvester score, but not fragmentation, predicts response to crt |
publisher |
Hindawi Limited |
series |
Cardiology Research and Practice |
issn |
2090-8016 2090-0597 |
publishDate |
2020-01-01 |
description |
Purpose. Myocardial scar is directly related to the response to CRT after implantation. The extent of myocardial scar can be detected not only by cardiac magnetic resonance but also by two electrocardiographic scores: fragmented QRS (fQRS) and Selvester score (SSc). The aim of our study is to compare the role of baseline SSc and fQRS in predicting response to CRT in a cohort of heart failure patients with true left bundle branch block (LBBB). As a secondary endpoint, we assessed the association of both scores with overall and cardiac mortality, heart failure hospitalizations, ventricular arrhythmias requiring ICD intervention, and major adverse cardiovascular event (MACE). Methods. We evaluated fQRS and SSc of 178 consecutive HF patients with severe systolic dysfunction (LVEF ≤ 35%), NYHA class II-III despite optimal medical treatment, and true-LBBB. Response to CRT was defined as the improvement of LVEF of at least 10% or as the reduction of LVESV of at least 15% at a 6-month follow-up. Each endpoint was related to fQRS and SSc. Results. SSc ≥7 was significantly associated with the absence of echocardiographic response to CRT (OR: 0.327; 95% C.I. 0.155–0.689; p=0.003), while the presence of fQRS at baseline ECG was not (OR: 1.133; 95% C.I. 0.539–2.381; p=0.742). No correlation was found between SSc and overall mortality, cardiac death, ventricular arrhythmias, hospitalizations due to heart failure, or for MACE. Similar results were observed between fQRS and all secondary endpoints. Conclusion. In HF patients with true-LBBB and LVEF ≤35% eligible for CRT, myocardial scar assessed by calculating the SSc on preimplant ECG is an independent predictor of nonresponse after multiple adjustments. Neither SSc nor fQRS is associated with overall and cardiac death, ventricular arrhythmias, or hospitalization for heart failure at a 24-month follow-up. |
url |
http://dx.doi.org/10.1155/2020/2036545 |
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