title: ECG myocardial scar quantification predicts reverse left ventricular remodeling and survival after cardiac resynchronization therapy implantation: A retrospective pilot study.
abstract: BACKGROUND
  Electrocardiographic (ECG) LV scar quantification may improve prediction of CRT response.
  
  
  RESULTS
  Data were abstracted in 76 patients who underwent a first CRT implantation at 2 US centers. Selvester QRS scar quantification was performed using the LBBB modified QRS scoring method. Seven clinical variables previously associated with reverse LV remodeling (RLVR) and QRS score were included in logistic regression analysis. Survival was compared across QRS score quartiles using Kaplan-Meier curves. RLVR occurred more frequently in patients with QRS score ≤ 5 (63%) than QRS score>5 (22%), (OR=5.83, 95% CI=2.11-16.07). After adjustment for clinical variables using logistic regression, QRS score>5 predicted RLVR (Chi-square=20.3, P=0.005, AUC=0.782). Patients in the lowest quartile of QRS score (<4) had improved survival compared to patients in the other QRS score quartiles (P=0.037).
  
  
  CONCLUSIONS
  ECG quantified LV scar predicts RLVR and long-term survival in patients with LBBB undergoing CRT implantation.
authors.affiliation: Duke University Medical Center, Durham, North Carolina; Durham Veterans Administration Medical Center, Durham, North Carolina. Electronic address: brett.atwater@duke.edu.
authors.forename: Brett D
authors.initials: BD
authors.lastname: Atwater
authors.affiliation: Duke University Medical Center, Durham, North Carolina.
authors.forename: Adefolakemi
authors.initials: A
authors.lastname: Babatunde
authors.affiliation: Stanford University, Palo Alto California.
authors.forename: Christopher
authors.initials: C
authors.lastname: Swan
authors.affiliation: Karolinska Institutet University Hospital, Stockholm, Sweden.
authors.forename: Bjorn
authors.initials: B
authors.lastname: Wieslander
authors.affiliation: Duke University Medical Center, Durham, North Carolina.
authors.forename: Abraham
authors.initials: A
authors.lastname: Andresen
authors.affiliation: Duke University Medical Center, Durham, North Carolina.
authors.forename: Dawn
authors.initials: D
authors.lastname: Rabineau
authors.affiliation: Duke University Medical Center, Durham, North Carolina.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Tomfohr
authors.affiliation: Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Galen
authors.initials: G
authors.lastname: Wagner
authors.affiliation: Duke University Medical Center, Durham, North Carolina.
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Jackson
authors.affiliation: Duke University Medical Center, Durham, North Carolina.
authors.forename: James P
authors.initials: JP
authors.lastname: Daubert
mesh_terms: D002921:Cicatrix / Q000175:diagnosis / Q000401:mortality*; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D003936:Diagnosis, Computer-Assisted / Q000379:methods; D004562:Electrocardiography / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D017682:Myocardial Stunning / Q000175:diagnosis / Q000401:mortality*; D009657:North Carolina / Q000453:epidemiology; D010865:Pilot Projects; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000401:mortality*
keywords: Cardiac resynchronization therapy; Electrocardiogram; Mortality; Response; Reverse remodeling