Kurisu Satoshi, Shimonaga Takashi, Ikenaga Hiroki, Watanabe Noriaki, Higaki Tadanao, Ishibashi Ken, Dohi Yoshihiro, Fukuda Yukihiro, Kihara Yasuki
Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3, Kasumi-cho, Minami-ku, Hiroshima, 734-8551, Japan.
Heart Vessels. 2017 Apr;32(4):369-375. doi: 10.1007/s00380-016-0884-0. Epub 2016 Aug 3.
Selvester QRS scoring system has an advantage of being inexpensive and easily accessible for estimating myocardial infarct (MI) size. We assessed the correlation and agreement between QRS score and total perfusion deficit (TPD) calculated by quantitative gated single-photon emission computed tomography (QGS) in patients with prior anterior MI undergoing coronary intervention. Sixty-six patients with prior anterior MI and 66 age- and sex-matched control subjects were enrolled. QRS score was obtained using a 50-criteria and 31-point system. QRS score was significantly higher in patients with prior anterior MI than control subjects (12.8 ± 8.9 vs 1.1 ± 2.7 %, p < 0.001). In overall patients (n = 132), QRS score was correlated well with TPD (r = 0.81, p < 0.001). This good correlation was found even in patients with TPD ≤40 % (n = 126) or in patients with TPD ≤30 % (n = 117). In overall patients, MI size estimated by QRS score was 7.0 ± 8.8 %, which was significantly smaller than TPD, 11.4 ± 14.0 % (p < 0.001). Bland-Altman plot showed that there was an increasing difference between QRS score and TPD with increasing MI size. When Blant-Altman plots were applied to patients with TPD ≤40 % and further in patients with TPD ≤30 %, the difference between QRS score and TPD became smaller, and the agreement became better. In overall patients, QRS score was correlated well with QGS measurements, such as end-diastolic volume (r = 0.62, p < 0.001), end-systolic volume (r = 0.67, p < 0.001), or ejection fraction (r = -0.73, p < 0.001). Our results suggest that QRS score reflects TPD well in patients with prior anterior MI, whose TPD is less than approximately 30 % even in the coronary intervention era.
塞尔维斯特QRS评分系统在评估心肌梗死（MI）面积方面具有成本低且易于获取的优势。我们评估了既往有前壁心肌梗死且接受冠状动脉介入治疗的患者的QRS评分与通过定量门控单光子发射计算机断层扫描（QGS）计算的总灌注缺损（TPD）之间的相关性和一致性。纳入了66例既往有前壁心肌梗死的患者和66例年龄及性别匹配的对照者。使用一个包含50项标准和31分的系统来获得QRS评分。既往有前壁心肌梗死的患者的QRS评分显著高于对照者（12.8±8.9 vs 1.1±2.7%，p<0.001）。在所有患者（n = 132）中，QRS评分与TPD相关性良好（r = 0.81，p<0.001）。即使在TPD≤40%的患者（n = 126）或TPD≤30%的患者（n = 117）中也发现了这种良好的相关性。在所有患者中，通过QRS评分估计的心肌梗死面积为7.0±8.8%，显著小于TPD的11.4±14.0%（p<0.001）。布兰德-奥特曼图显示，随着心肌梗死面积增加，QRS评分与TPD之间的差异增大。当将布兰德-奥特曼图应用于TPD≤40%的患者以及进一步应用于TPD≤30%的患者时，QRS评分与TPD之间的差异变小，一致性变好。在所有患者中，QRS评分与QGS测量值，如舒张末期容积（r = 0.62，p<0.001）、收缩末期容积（r = 0.67，p<0.001）或射血分数（r = -0.73，p<0.001）相关性良好。我们的结果表明，在既往有前壁心肌梗死的患者中，即使在冠状动脉介入治疗时代，当TPD小于约30%时，QRS评分能很好地反映TPD。
