title: Evaluation of the ECG based Selvester scoring method to estimate myocardial scar burden and predict clinical outcome in patients with left bundle branch block, with comparison to late gadolinium enhancement CMR imaging.
abstract: BACKGROUND
  Myocardial scar burden quantification is an emerging clinical parameter for risk stratification of sudden cardiac death and prediction of ventricular arrhythmias in patients with left ventricular dysfunction. We investigated the relationships among semiautomated Selvester score burden and late gadolinium enhancement-cardiovascular magnetic resonance (LGE-CMR) assessed scar burden and clinical outcome in patients with underlying heart failure, left bundle branch block (LBBB) and implantable cardioverter-defibrillator (ICD) treatment.
  
  
  METHODS
  Selvester QRS scoring was performed on all subjects with ischemic and nonischemic dilated cardiomyopathy at Skåne University Hospital Lund (2002-2013) who had undergone LGE-CMR and 12-lead ECG with strict LBBB pre-ICD implantation.
  
  
  RESULTS
  Sixty patients were included; 57% nonischemic dilated cardiomyopathy and 43% ischemic cardiomyopathy with mean left ventricular ejection fraction of 27.6% ± 11.7. All patients had scar by Selvester scoring. Sixty-two percent had scar by LGE-CMR (n = 37). The Spearman correlation coefficient for LGE-CMR and Selvester score derived scar was r = .35 (p = .007). In scar negative LGE-CMR, there was evidence of scar by Selvester scoring in all patients (range 3%-33%, median 15%). Fourteen patients (23%) had an event during the follow-up period; 11 (18%) deaths and six adequate therapies (10%). There was a moderate trend indicating that presence of scar increased the risk of clinical endpoints in the LGE-CMR analysis (p = .045).
  
  
  CONCLUSIONS
  There is a modest correlation between LGE-CMR and Selvester scoring verified myocardial scar. CMR based scar burden is correlated to clinical outcome, but Selvester scoring is not. The Selvester scoring algorithm needs to be further refined in order to be clinically relevant and reliable for detailed scar evaluation in patients with LBBB.
authors.affiliation: Arrhythmia Clinic, Skåne University Hospital, Lund, Sweden.|Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden.
authors.forename: Uzma
authors.identifier: http://orcid.org/0000-0001-5186-0252
authors.initials: U
authors.lastname: Chaudhry
authors.affiliation: Arrhythmia Clinic, Skåne University Hospital, Lund, Sweden.|Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden.
authors.forename: Pyotr G
authors.initials: PG
authors.lastname: Platonov
authors.affiliation: Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital and Lund University, Lund, Sweden.
authors.forename: Robert
authors.initials: R
authors.lastname: Jablonowski
authors.affiliation: Heart Research Follow-Up Program, University of Rochester, Rochester, NY, USA.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Couderc
authors.affiliation: Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital and Lund University, Lund, Sweden.
authors.forename: Henrik
authors.initials: H
authors.lastname: Engblom
authors.affiliation: Heart Research Follow-Up Program, University of Rochester, Rochester, NY, USA.
authors.forename: Xiajuang
authors.initials: X
authors.lastname: Xia
authors.affiliation: Department of Clinical Physiology, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Björn
authors.initials: B
authors.lastname: Wieslander
authors.affiliation: Duke Clinical Research Institute, Durham, NC, USA.
authors.forename: Brett D
authors.initials: BD
authors.lastname: Atwater
authors.affiliation: Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD, USA.
authors.forename: David G
authors.initials: DG
authors.lastname: Strauss
authors.affiliation: Arrhythmia Clinic, Skåne University Hospital, Lund, Sweden.|Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden.
authors.forename: Jesper
authors.initials: J
authors.lastname: Van der Pals
authors.affiliation: Department of Clinical Physiology, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Martin
authors.initials: M
authors.lastname: Ugander
authors.affiliation: Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital and Lund University, Lund, Sweden.
authors.forename: Marcus
authors.initials: M
authors.lastname: Carlsson
authors.affiliation: Arrhythmia Clinic, Skåne University Hospital, Lund, Sweden.|Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden.
authors.forename: Rasmus
authors.initials: R
authors.lastname: Borgquist
mesh_terms: D000368:Aged; D002037:Bundle-Branch Block / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D002921:Cicatrix / Q000150:complications / Q000503:physiopathology*; D003287:Contrast Media; D017281:Cost of Illness; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D005682:Gadolinium; D006321:Heart / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012720:Severity of Illness Index
chemical_list: D003287:Contrast Media; D005682:Gadolinium
keywords: Selvester scoring; cardiovascular magnetic resonance; implantable cardioverter-defibrillator device; late gadolinium enhancement; left bundle branch block; myocardial scar