12 导联心电图 Selvester QRS 评分标准诊断肥厚型心肌病患者心肌瘢痕的性能。
Performance of 12-lead electrocardiogram Selvester QRS scoring criteria to diagnose myocardial scar in patients with hypertrophic cardiomyopathy.
机构信息
Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
Department of Cardiovascular Ultrasound and Noninvasive Cardiology, Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, China.
出版信息
Ann Noninvasive Electrocardiol. 2020 Sep;25(5):e12762. doi: 10.1111/anec.12762. Epub 2020 May 7.
BACKGROUND
The Selvester QRS score can identify the presence and extent of myocardial scar in ischemic and nonischemic cardiomyopathy, but its performance in patients with hypertrophic cardiomyopathy (HCM) has not been assessed.
METHODS
Consecutive patients with HCM referred to our hospital between January 2012 and July 2016 were prospectively enrolled. All patients underwent cardiac magnetic resonance (CMR) and 12-lead electrocardiography. The Selvester QRS score was used to evaluate the presence and extent of myocardial scarring, and the results were compared with that obtained with the gold standard-late gadolinium enhancement (LGE) on CMR.
RESULTS
A total of 135 HCM patients were enrolled. LGE was present in 93 of 135 (69%) patients. The median LGE mass was 5 (0-14) g, and the median proportion of total left ventricular mass showing LGE was 4% (0%-10%). A total of 92 patients had Selvester score ≥1. The highest score recorded was 13; the median score was 1 (0-3). In receiver operating curve analysis, Selvester score ≥1 was identified as the optimum score for predicting presence of LGE enhancement; the area under the curve was 0.826 (95% CI, 0.752-0.900; p < .001). Significant positive correlation was seen between the Selvester score and the extent of LGE enhancement (Spearman ρ, .572; p < .001). The Selvester scoring system correctly identified all LGE segments in 13 of 93 (14%) patients and some LGE segments in 39 (41.9%) patients.
CONCLUSIONS
The Selvester QRS score appears to be a convenient and reliable method to determine the presence and extent of myocardial scar in patients with HCM.
背景
Selvester QRS 评分可用于识别缺血性和非缺血性心肌病患者心肌瘢痕的存在和程度，但尚未评估其在肥厚型心肌病（HCM）患者中的表现。
方法
连续纳入 2012 年 1 月至 2016 年 7 月期间我院就诊的 HCM 患者。所有患者均行心脏磁共振（CMR）和 12 导联心电图检查。采用 Selvester QRS 评分评估心肌瘢痕的存在和程度，并与 CMR 金标准-延迟钆增强（LGE）结果进行比较。
结果
共纳入 135 例 HCM 患者，其中 93 例（69%）存在 LGE。LGE 质量中位数为 5（0-14）g，左心室总质量中显示 LGE 的中位数比例为 4%（0%-10%）。共有 92 例患者 Selvester 评分≥1，记录的最高得分为 13，中位数得分为 1（0-3）。在受试者工作特征曲线分析中，Selvester 评分≥1 被确定为预测 LGE 增强存在的最佳评分；曲线下面积为 0.826（95%CI，0.752-0.900；p<.001）。Selvester 评分与 LGE 增强程度之间存在显著正相关（Spearman ρ，.572；p<.001）。Selvester 评分系统正确识别了 93 例患者中 13 例（14%）患者的所有 LGE 节段和 39 例（41.9%）患者的部分 LGE 节段。
结论
Selvester QRS 评分似乎是一种方便、可靠的方法，可用于确定 HCM 患者心肌瘢痕的存在和程度。
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