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

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Abstract

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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Acknowledgements

The authors thank the patients who participated in the study and the staff of the Department of Nuclear Medicine.

Funding

This study was supported by research Grants from the Swiss National Science Foundation, the Swiss Heart Foundation, the Cardiovascular Research Foundation Basel, the University Hospital Basel, Abbott and BRAHMS.

Author information

Author notes

  1. Patrick Badertscher and Ivo Strebel have contributed equally to this analysis and should please be considered co-first authors.

Authors and Affiliations

  1. Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland

    Patrick Badertscher, Ivo Strebel, Ursina Honegger, Nicolas Schaerli, Deborah Mueller, Christian Puelacher, Max Wagener, Roger Abächerli, Joan Walter, Zaid Sabti, Lorraine Sazgary, Stella Marbot, Jeanne du Fay de Lavallaz, Raphael Twerenbold, Jasper Boeddinghaus, Thomas Nestelberger, Nikola Kozhuharov, Tobias Breidthardt, Samyut Shrestha, Dayana Flores, Carmela Schumacher, Stefan Osswald, Michael J. Zellweger, Christian Mueller & Tobias Reichlin

  2. Insitute for Medical Engineering (IMT), Lucerne University of Applied Sciences and Arts, Horw, Switzerland

    Roger Abächerli

  3. Clinic for General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany

    Raphael Twerenbold

  4. Department of Internal Medicine, University Hospital Basel, University of Basel, Basel, Switzerland

    Tobias Breidthardt

  5. Division of Nuclear Medicine, University Hospital Basel, University Basel, Basel, Switzerland

    Damian Wild

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  1. Patrick Badertscher
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Corresponding author

Correspondence to Tobias Reichlin.

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Conflict of interest

Dr. Mueller has received research support from the Swiss National Science Foundation, the Swiss Heart Foundation, the Cardiovascular Research Foundation Basel, Abbott, Beckman Coulter, BRAHMS, Roche, Siemens. and the University Hospital Basel, as well as speaker honoraria from Abbott, ALERE, Astra Zeneca, BG Medicine, Biomerieux, Brahms, Cardiorentis, Lilly, Novartis, Roche, and Siemens. Dr. Reichlin has received research grants from the Goldschmidt-Jacobson Foundation, the Swiss National Science Foundation (PASMP3-136995) the Swiss Heart Foundation, the Professor Max Cloëtta Foundation, the Cardiovascular Research Foundation Basel, the University of Basel and the University Hospital Basel as well as speaker honoraria from Brahms and Roche. Dr. Twerenbold has received research support from the Swiss National Science Foundation (P300PB-167803/1) and speaker honoraria/consulting honoraria from Roche, Abbott, Siemens and Brahms. Dr. Boeddinghaus has received speaker honoraria from Siemens. All other authors declare that they have no conflict of interest with this study.

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Badertscher, P., Strebel, I., Honegger, U. et al. Automatically computed ECG algorithm for the quantification of myocardial scar and the prediction of mortality. Clin Res Cardiol 107, 824–835 (2018). https://doi.org/10.1007/s00392-018-1253-z

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  • DOI: https://doi.org/10.1007/s00392-018-1253-z

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