title: Screening for Cardiac Magnetic Resonance Scar Features by 12-Lead ECG, in Patients with Preserved Ejection Fraction.
abstract: BACKGROUND
  Increased QRS score and wide spatial QRS-T angle are independent predictors of cardiovascular mortality in the general population. Our main objective was to assess whether a QRS score ≥ 5 and/or QRS-T angle ≥ 105° enable screening of patients for myocardial scar features.
  
  
  METHODS
  Seventy-seven patients of age ≤ 70 years with QRS score ≥ 5 and/or spatial QRS-T angle ≥ 105° as well as left ventricular ejection fraction (LVEF) >35% were enrolled in the study. All participants underwent complete clinical examination, signal-averaged ECG (SAECG), 30-minute ambulatory ECG recording for T-wave alternans (TWA), and late gadolinium enhancement cardiac magnetic resonance (LGE-CMR). Relationship between QRS score, QRS-T angle with scar presence and pattern, as well as gray zone, core, and total scar size by LGE-CMR were assessed.
  
  
  RESULTS
  Myocardial scar was present in 41 (53%) patients, of whom 19 (46%) exhibited a typical ischemic pattern. QRS score but not QRS-T angle was related to total scar size and gray zone size (R(2) = 0.12, P = 0.002; R(2) = 0.17; P ≤ 0.0001, respectively). Patients with QRS scores ≥ 6 had significantly greater myocardial scar and gray zone size, increased QRS duration and QRS-T angle, a higher prevalence of late potentials (LPs) presence, increased LV end-diastolic volume and decreased LVEF. There was a significant independent and positive association between TWA value and total scar (P = 0.001) and gray zone size (P = 0.01).
  
  
  CONCLUSIONS
  Patients with preserved LVEF and myocardial scar by CMR also have electrocardiographic features that could be involved in ventricular arrhythmogenesis.
authors.affiliation: Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD.|Hôpital Cardiovasculaire Louis Pradel, Centre d'Investigation Clinique, Hospices Civils de Lyon, Bron, France.
authors.forename: Nathan
authors.initials: N
authors.lastname: Mewton
authors.affiliation: Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD.
authors.forename: David G
authors.initials: DG
authors.lastname: Strauss
authors.affiliation: Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Patricia
authors.initials: P
authors.lastname: Rizzi
authors.affiliation: Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Verrier
authors.affiliation: Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Chia Ying
authors.initials: CY
authors.lastname: Liu
authors.affiliation: Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Larisa G
authors.initials: LG
authors.lastname: Tereshchenko
authors.affiliation: Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
authors.forename: Bruce
authors.initials: B
authors.lastname: Nearing
authors.affiliation: Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Gustavo J
authors.initials: GJ
authors.lastname: Volpe
authors.affiliation: Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: Francis E
authors.initials: FE
authors.lastname: Marchlinski
authors.affiliation: Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: John
authors.initials: J
authors.lastname: Moxley
authors.affiliation: Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: Tony
authors.initials: T
authors.lastname: Killian
authors.affiliation: Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Katherine C
authors.initials: KC
authors.lastname: Wu
authors.affiliation: Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Peter
authors.initials: P
authors.lastname: Spooner
authors.affiliation: Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: João A C
authors.initials: JA
authors.lastname: Lima
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000175:diagnosis; D002921:Cicatrix / Q000175:diagnosis*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis*; D013318:Stroke Volume; D055815:Young Adult
keywords: T-wave alternans; death, sudden; magnetic resonance imaging; myocardial scar; screening