title: QRS-based assessment of myocardial damage and adverse events associated with cardiac sarcoidosis.
abstract: BACKGROUND
  Cardiac sarcoidosis (CS) generates myocardial scar and arrhythmogenic substrate. CS diagnosis according to the Japanese Ministry of Health and Welfare guidelines relies, among others, on cardiac magnetic resonance imaging with late gadolinium enhancement (CMR-LGE). However, access to CMR-LGE is limited. The electrocardiography-based Selvester QRS score has been validated for identifying myocardial scar in ischemic/nonischemic cardiomyopathy, but its efficacy has not been tested to evaluate CS.
  
  
  OBJECTIVE
  The purpose of this study was to examine whether the QRS score can be applied to CS.
  
  
  METHODS
  CS-associated myocardial scar was assessed by both CMR-LGE and QRS scoring in patients with extra-CS (n = 59).
  
  
  RESULTS
  Of 59 patients, 35 (59%) were diagnosed with CS according to the Japanese Ministry of Health and Welfare guidelines. QRS-estimated scar mass positively correlated with that quantified by CMR-LGE (signal intensity ≥2SD above the reference; r = 0.68; P < .001). Receiver operating characteristic curves demonstrated optimal cutoffs of 9% CMR-LGE scar and 3-point QRS score to identify patients with CS. The areas under the curves of CMR-LGE and the QRS score were not significantly different (0.83 and 0.78, respectively; P = .27); both methods demonstrated similar diagnostic performance. A QRS score of ≥3 led to a higher incidence of CS-associated adverse events (death/fatal arrhythmia/heart failure hospitalization) than did a QRS score of <3 (35 ± 21 months of follow-up; P = .01). QRS score was an independent predictor of risk in multivariate analysis (P = .03).
  
  
  CONCLUSIONS
  The Selvester QRS scoring estimates CS-associated myocardial damage and identifies patients with CS equally well as CMR-LGE. A higher QRS score is also associated with an increased risk of life-threatening events in CS, indicating its potential use as a risk predictor.
authors.affiliation: Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Sobue
authors.affiliation: Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan. Electronic address: mharada@fujita-hu.ac.jp.
authors.forename: Masahide
authors.initials: M
authors.lastname: Harada
authors.affiliation: Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Koshikawa
authors.affiliation: Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan.
authors.forename: Tomohide
authors.initials: T
authors.lastname: Ichikawa
authors.affiliation: Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan.
authors.forename: Mayumi
authors.initials: M
authors.lastname: Yamamoto
authors.affiliation: Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Okuda
authors.affiliation: Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan.
authors.forename: Yasuchika
authors.initials: Y
authors.lastname: Kato
authors.affiliation: Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan.
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Sarai
authors.affiliation: Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan.
authors.forename: Eiichi
authors.initials: E
authors.lastname: Watanabe
authors.affiliation: Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Ozaki
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D009202:Cardiomyopathies / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D015331:Cohort Studies; D003287:Contrast Media; D004562:Electrocardiography; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012507:Sarcoidosis / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA
keywords: Cardiac magnetic resonance imaging; Cardiac sarcoidosis; Electrocardiography; Myocardial scar; Selvester QRS score