Automatically computed ECG algorithm for the quantification of myocardial scar and the prediction of mortality.

Badertscher, Patrick; Strebel, Ivo; Honegger, Ursina; Schaerli, Nicolas; Mueller, Deborah; Puelacher, Christian; Wagener, Max; Abächerli, Roger; Walter, Joan; Sabti, Zaid; Sazgary, Lorraine; Marbot, Stella; du Fay de Lavallaz, Jeanne; Twerenbold, Raphael; Boeddinghaus, Jasper; Nestelberger, Thomas; Kozhuharov, Nikola; Breidthardt, Tobias; Shrestha, Samyut; Flores, Dayana; ... (2018). Automatically computed ECG algorithm for the quantification of myocardial scar and the prediction of mortality. Clinical research in cardiology, 107(9), pp. 824-835. Springer-Verlag 10.1007/s00392-018-1253-z

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BACKGROUND

Myocardial scar is associated with adverse cardiac outcomes. The Selvester QRS-score was developed to estimate myocardial scar from the 12-lead ECG, but its manual calculation is difficult. An automatically computed QRS-score would allow identification of patients with myocardial scar and an increased risk of mortality.

OBJECTIVES

To assess the diagnostic and prognostic value of the automatically computed QRS-score.

METHODS

The diagnostic value of the QRS-score computed automatically from a standard digital 12-lead was prospectively assessed in 2742 patients with suspected myocardial ischemia referred for myocardial perfusion imaging (MPI). The prognostic value of the QRS-score was then prospectively tested in 1151 consecutive patients presenting to the emergency department (ED) with suspected acute heart failure (AHF).

RESULTS

Overall, the QRS-score was significantly higher in patients with more extensive myocardial scar: the median QRS-score was 3 (IQR 2-5), 4 (IQR 2-6), and 7 (IQR 4-10) for patients with 0, 5-20 and > 20% myocardial scar as quantified by MPI (p < 0.001 for all pairwise comparisons). A QRS-score ≥ 9 (n = 284, 10%) predicted a large scar defined as > 20% of the LV with a specificity of 91% (95% CI 90-92%). Regarding clinical outcomes in patients presenting to the ED with symptoms suggestive of AHF, mortality after 1 year was 28% in patients with a QRS-score ≥ 3 as opposed to 20% in patients with a QRS-score < 3 (p = 0.001).

CONCLUSIONS

The QRS-score can be computed automatically from the 12-lead ECG for simple, non-invasive and inexpensive detection and quantification of myocardial scar and for the prediction of mortality. TRIAL-REGISTRATION: http://www.clinicaltrials.gov . Identifier, NCT01838148 and NCT01831115.

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