Abstract 19465: QRS Scoring System for Early Estimation of Myocardial Infarct Size and Its Ability to Accurately Predict Ejection Fraction at 3 Months and the Need for Early AICD Implantation
Background: Given the existing controversy regarding the appropriate determination time for placement of implantable cardioverter-defibrillator (ICD) in patients at risk for sudden cardiac death (SCD) following acute myocardial infarction (AMI) and because of the fact that the highest incidence of SCD occurs in the first 3 months after an event. We proposed to evaluate whether quantification of left ventricular (LV) scar size shortly after AMI using the well validated Selvester QRS score strongly correlates with ejection fraction at 3 months.
Methods: A total of 28 consecutive post-AMI patients were included in this study. All patients had STEMI and underwent cardiac catheterization. EKGs before discharge were analyzed to calculate QRS score (32 criteria). We used adjusted criteria for each of the following abnormalities: left and right ventricular hypertrophy (LVH and RVH, respectively), left anterior fascicular block (LAFB), left bundle-branch block (LBBB), right bundle-branch block (RBBB), RBBB + LAFB, and no confounders. Echocardiogram was obtained at 3 months to assess LVEF. Linear and logistic regression analyses were performed.
Results: 28 patients with mean age was 58, male 60%. The linear regression analysis showed a strong correlation coefficient between QRS score early after AMI and LVEF (r: -0.7987044 with a
P-value (two-tailed) <0.0001). Likewise, the logistic regression analysis revealed that Selvester QRS score of 8 or higher can accurately predict an ejection fraction at 3 months of 35% or less with a sensitivity of 100% and a specificity of 94.7%.
Conclusion: Patients with a QRS score of more than 8 probably will remain with low LVEF at three months despite of optimal medical therapy. This score can be helpful in managing this high-risk population with early IACD implantation.
Author Disclosures: J. Romero: None. R.A. Estrada: None. N. Tiwari: None. A.A. Holmes: None. A. Ahmed: None. E. Manheimer: None. M.J. Garcia: None.
- © 2014 by American Heart Association, Inc.