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J Electrocardiol. 2018 Sep - Oct;51(5):779-786. doi: 10.1016/j.jelectrocard.2018.05.019. Epub 2018 May 30.

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

Author information

1
Department of Clinical Physiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
2
Heart Research Follow-Up Program, University of Rochester, NY, USA.
3
Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Lund University, Lund, Sweden.
4
Division of Cardiology, Duke University Medical Center, Durham, NC, USA.
5
Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands.
6
Department of Health Services, University of Washington, Seattle, WA, USA.
7
University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
8
Department of Clinical Physiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden; Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.
9
Arrhythmia Clinic, Skane University Hospital, Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden.
10
Department of Clinical Physiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden; Division of Applied Regulatory Science, Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA.
11
Department of Clinical Physiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden. Electronic address: martin.ugander@gmail.com.

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 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.

KEYWORDS:

Cardiovascular magnetic resonance; Electrocardiography; Left bundle branch block; Myocardial scar; Selvester QRS score

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