Screening for Cardiac Magnetic Resonance Scar Features by 12-Lead ECG, in Patients with Preserved Ejection Fraction

Nathan Mewton, David G. Strauss, Patricia Rizzi, Richard L. Verrier, Chia Ying Liu, Larisa G. Tereshchenko, Bruce Nearing, Gustavo J. Volpe, Francis E. Marchlinski, John Moxley, Tony Killian, Katherine C. Wu, Peter Spooner, João A C Lima

Research output: Contribution to journalArticle

Abstract

Background: Increased QRS score and wide spatial QRS-T angle are independent predictors of cardiovascular mortality in the general population. Our main objective was to assess whether a QRS score ≥5 and/or QRS-T angle ≥105° enable screening of patients for myocardial scar features. Methods: Seventy-seven patients age ≤70 years with QRS score ≥5 AND/OR spatial QRS-T angle ≥105° as well as left ventricular ejection fraction (LVEF) >35% were enrolled in the study. All participants underwent complete clinical examination, signal averaged ECG (SAECG), 30-minute ambulatory electrocardiogram recording for T-wave alternans (TWA), and late gadolinium enhancement cardiac magnetic resonance (LGE-CMR). Relationship between QRS score, QRS-T angle with scar presence and pattern, as well as gray zone, core, and total scar size by LGE-CMR were assessed. Results: Myocardial scar was present in 41 (53%) patients, of whom 19 (46%) exhibited a typical ischemic pattern. QRS score but not QRS-T angle was related to total scar size and gray zone size (R2 = 0.12, P = 0.002; R2 = 0.17; P ≤ 0.0001, respectively). Patients with QRS scores ≥6 had significantly greater myocardial scar and gray zone size, increased QRS duration and QRS-T angle, a higher prevalence of late potentials presence, increased LV end-diastolic volume and decreased LVEF. There was a significant independent and positive association between TWA value and total scar (P = 0.001) and gray zone size (P = 0.01). Conclusion: Patients with preserved LVEF and myocardial scar by CMR also have electrocardiographic features that could be involved in ventricular arrhythmogenesis.

Original languageEnglish (US)
JournalAnnals of Noninvasive Electrocardiology
DOIs
StateAccepted/In press - 2015

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Cicatrix
Electrocardiography
Magnetic Resonance Spectroscopy
Stroke Volume
Gadolinium
Lead
Mortality
Population

Keywords

  • Death, sudden
  • Magnetic resonance imaging
  • Myocardial scar
  • Screening
  • T-wave alternans

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Mewton, N., Strauss, D. G., Rizzi, P., Verrier, R. L., Liu, C. Y., Tereshchenko, L. G., ... Lima, J. A. C. (Accepted/In press). Screening for Cardiac Magnetic Resonance Scar Features by 12-Lead ECG, in Patients with Preserved Ejection Fraction. Annals of Noninvasive Electrocardiology. https://doi.org/10.1111/anec.12279

Screening for Cardiac Magnetic Resonance Scar Features by 12-Lead ECG, in Patients with Preserved Ejection Fraction. / Mewton, Nathan; Strauss, David G.; Rizzi, Patricia; Verrier, Richard L.; Liu, Chia Ying; Tereshchenko, Larisa G.; Nearing, Bruce; Volpe, Gustavo J.; Marchlinski, Francis E.; Moxley, John; Killian, Tony; Wu, Katherine C.; Spooner, Peter; Lima, João A C.

In: Annals of Noninvasive Electrocardiology, 2015.

Research output: Contribution to journalArticle

Mewton, N, Strauss, DG, Rizzi, P, Verrier, RL, Liu, CY, Tereshchenko, LG, Nearing, B, Volpe, GJ, Marchlinski, FE, Moxley, J, Killian, T, Wu, KC, Spooner, P & Lima, JAC 2015, 'Screening for Cardiac Magnetic Resonance Scar Features by 12-Lead ECG, in Patients with Preserved Ejection Fraction', Annals of Noninvasive Electrocardiology. https://doi.org/10.1111/anec.12279
Mewton, Nathan ; Strauss, David G. ; Rizzi, Patricia ; Verrier, Richard L. ; Liu, Chia Ying ; Tereshchenko, Larisa G. ; Nearing, Bruce ; Volpe, Gustavo J. ; Marchlinski, Francis E. ; Moxley, John ; Killian, Tony ; Wu, Katherine C. ; Spooner, Peter ; Lima, João A C. / Screening for Cardiac Magnetic Resonance Scar Features by 12-Lead ECG, in Patients with Preserved Ejection Fraction. In: Annals of Noninvasive Electrocardiology. 2015.
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abstract = "Background: Increased QRS score and wide spatial QRS-T angle are independent predictors of cardiovascular mortality in the general population. Our main objective was to assess whether a QRS score ≥5 and/or QRS-T angle ≥105° enable screening of patients for myocardial scar features. Methods: Seventy-seven patients age ≤70 years with QRS score ≥5 AND/OR spatial QRS-T angle ≥105° as well as left ventricular ejection fraction (LVEF) >35{\%} were enrolled in the study. All participants underwent complete clinical examination, signal averaged ECG (SAECG), 30-minute ambulatory electrocardiogram recording for T-wave alternans (TWA), and late gadolinium enhancement cardiac magnetic resonance (LGE-CMR). Relationship between QRS score, QRS-T angle with scar presence and pattern, as well as gray zone, core, and total scar size by LGE-CMR were assessed. Results: Myocardial scar was present in 41 (53{\%}) patients, of whom 19 (46{\%}) exhibited a typical ischemic pattern. QRS score but not QRS-T angle was related to total scar size and gray zone size (R2 = 0.12, P = 0.002; R2 = 0.17; P ≤ 0.0001, respectively). Patients with QRS scores ≥6 had significantly greater myocardial scar and gray zone size, increased QRS duration and QRS-T angle, a higher prevalence of late potentials presence, increased LV end-diastolic volume and decreased LVEF. There was a significant independent and positive association between TWA value and total scar (P = 0.001) and gray zone size (P = 0.01). Conclusion: Patients with preserved LVEF and myocardial scar by CMR also have electrocardiographic features that could be involved in ventricular arrhythmogenesis.",
keywords = "Death, sudden, Magnetic resonance imaging, Myocardial scar, Screening, T-wave alternans",
author = "Nathan Mewton and Strauss, {David G.} and Patricia Rizzi and Verrier, {Richard L.} and Liu, {Chia Ying} and Tereshchenko, {Larisa G.} and Bruce Nearing and Volpe, {Gustavo J.} and Marchlinski, {Francis E.} and John Moxley and Tony Killian and Wu, {Katherine C.} and Peter Spooner and Lima, {Jo{\~a}o A C}",
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T1 - Screening for Cardiac Magnetic Resonance Scar Features by 12-Lead ECG, in Patients with Preserved Ejection Fraction

AU - Mewton, Nathan

AU - Strauss, David G.

AU - Rizzi, Patricia

AU - Verrier, Richard L.

AU - Liu, Chia Ying

AU - Tereshchenko, Larisa G.

AU - Nearing, Bruce

AU - Volpe, Gustavo J.

AU - Marchlinski, Francis E.

AU - Moxley, John

AU - Killian, Tony

AU - Wu, Katherine C.

AU - Spooner, Peter

AU - Lima, João A C

PY - 2015

Y1 - 2015

N2 - Background: Increased QRS score and wide spatial QRS-T angle are independent predictors of cardiovascular mortality in the general population. Our main objective was to assess whether a QRS score ≥5 and/or QRS-T angle ≥105° enable screening of patients for myocardial scar features. Methods: Seventy-seven patients age ≤70 years with QRS score ≥5 AND/OR spatial QRS-T angle ≥105° as well as left ventricular ejection fraction (LVEF) >35% were enrolled in the study. All participants underwent complete clinical examination, signal averaged ECG (SAECG), 30-minute ambulatory electrocardiogram recording for T-wave alternans (TWA), and late gadolinium enhancement cardiac magnetic resonance (LGE-CMR). Relationship between QRS score, QRS-T angle with scar presence and pattern, as well as gray zone, core, and total scar size by LGE-CMR were assessed. Results: Myocardial scar was present in 41 (53%) patients, of whom 19 (46%) exhibited a typical ischemic pattern. QRS score but not QRS-T angle was related to total scar size and gray zone size (R2 = 0.12, P = 0.002; R2 = 0.17; P ≤ 0.0001, respectively). Patients with QRS scores ≥6 had significantly greater myocardial scar and gray zone size, increased QRS duration and QRS-T angle, a higher prevalence of late potentials presence, increased LV end-diastolic volume and decreased LVEF. There was a significant independent and positive association between TWA value and total scar (P = 0.001) and gray zone size (P = 0.01). Conclusion: Patients with preserved LVEF and myocardial scar by CMR also have electrocardiographic features that could be involved in ventricular arrhythmogenesis.

AB - Background: Increased QRS score and wide spatial QRS-T angle are independent predictors of cardiovascular mortality in the general population. Our main objective was to assess whether a QRS score ≥5 and/or QRS-T angle ≥105° enable screening of patients for myocardial scar features. Methods: Seventy-seven patients age ≤70 years with QRS score ≥5 AND/OR spatial QRS-T angle ≥105° as well as left ventricular ejection fraction (LVEF) >35% were enrolled in the study. All participants underwent complete clinical examination, signal averaged ECG (SAECG), 30-minute ambulatory electrocardiogram recording for T-wave alternans (TWA), and late gadolinium enhancement cardiac magnetic resonance (LGE-CMR). Relationship between QRS score, QRS-T angle with scar presence and pattern, as well as gray zone, core, and total scar size by LGE-CMR were assessed. Results: Myocardial scar was present in 41 (53%) patients, of whom 19 (46%) exhibited a typical ischemic pattern. QRS score but not QRS-T angle was related to total scar size and gray zone size (R2 = 0.12, P = 0.002; R2 = 0.17; P ≤ 0.0001, respectively). Patients with QRS scores ≥6 had significantly greater myocardial scar and gray zone size, increased QRS duration and QRS-T angle, a higher prevalence of late potentials presence, increased LV end-diastolic volume and decreased LVEF. There was a significant independent and positive association between TWA value and total scar (P = 0.001) and gray zone size (P = 0.01). Conclusion: Patients with preserved LVEF and myocardial scar by CMR also have electrocardiographic features that could be involved in ventricular arrhythmogenesis.

KW - Death, sudden

KW - Magnetic resonance imaging

KW - Myocardial scar

KW - Screening

KW - T-wave alternans

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