Wieslander Björn, Wu Katherine C, Loring Zak, Andersson Linus G, Frank Terry F, Gerstenblith Gary, Tomaselli Gordon F, Weiss Robert G, Wagner Galen S, Ugander Martin, Strauss David G
Cardiac MR Group, Department of Clinical Physiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
J Electrocardiol. 2013 May-Jun;46(3):249-55. doi: 10.1016/j.jelectrocard.2013.02.006. Epub 2013 Mar 26.
Outcome of cardiac resynchronization therapy is severely worsened by myocardial scar at the left ventricular (LV) pacing site. We aimed to describe the diagnostic performance of electrocardiographic (ECG) criteria based on the Selvester QRS scoring system, first in localizing myocardial scar and second in screening for any non-septal scar in patients with strictly defined LBBB.
In 39 cardiomyopathy patients with LBBB, 17 with scar, 22 without scar, late gadolinium-enhancement cardiac magnetic resonance images (CMR-LGE) and 12-lead ECGs were analyzed for scar presence in 5 LV wall segments. The ECG criteria with the best diagnostic performance in detecting scar in each segment and in the four non-septal segments together were identified. Criteria for detecting non-septal scar had 75% (95% CI: 51%-90%) sensitivity, 95% (78%-99%) specificity, 92% (67%-99%) positive predictive value and 84% (65%-94%) negative predictive value. For each individual wall segment, 40%-60% sensitivities and 77%-100% specificities were found.
The 12-lead ECG can convey information about scar presence and location in this population of cardiomyopathy patients with LBBB. ECG screening criteria for scar in potential CRT LV pacing sites were identified. Further exploration is required to determine the clinical utility of the 12-lead ECG in combination with other imaging modalities to screen for scar in potential LV pacing sites in CRT candidates.
左心室（LV）起搏部位的心肌瘢痕会严重恶化心脏再同步治疗的效果。我们旨在描述基于塞尔维斯特QRS评分系统的心电图（ECG）标准的诊断性能，首先是定位心肌瘢痕，其次是筛查严格定义的左束支传导阻滞（LBBB）患者中的任何非间隔瘢痕。
对39例患有LBBB的心肌病患者进行研究，其中17例有瘢痕，22例无瘢痕，分析其钆延迟增强心脏磁共振成像（CMR-LGE）和12导联心电图，以确定左心室5个壁段是否存在瘢痕。确定了在检测每个节段以及四个非间隔节段中的瘢痕时诊断性能最佳的心电图标准。检测非间隔瘢痕的标准具有75%（95%CI：51%-90%）的敏感性、95%（78%-99%）的特异性、92%（67%-99%）的阳性预测值和84%（65%-94%）的阴性预测值。对于每个单独的壁段，敏感性为40%-60%，特异性为77%-100%。
12导联心电图可以传达有关此类患有LBBB的心肌病患者瘢痕存在和位置的信息。确定了潜在心脏再同步治疗左心室起搏部位瘢痕的心电图筛查标准。需要进一步探索以确定12导联心电图与其他成像方式联合用于筛查心脏再同步治疗候选者潜在左心室起搏部位瘢痕的临床效用。
