Prognostic value of the Selvester QRS score for re-hospitalization in patients with ischemic heart failure

Yıl 2020, Cilt: 4 Sayı: 12, 1165 - 1168, 01.12.2020

Alper Karakuş Berat Uğuz

https://doi.org/10.28982/josam.829084

Cited By: 1

Öz

Aim: The Selvester QRS score (SSc) on surface electrocardiogram (ECG) has prognostic value in various cardiac events related to myocardial scarring. Furthermore, the SSc system has been validated by post-mortem studies. In this cohort, we assessed the utility of the SSc system for prediction of re-hospitalization in patients with ischemic heart failure (HF).
Methods: In this retrospective cohort study, the data of fifty-four consecutive patients with ischemic HF were analyzed. ECGs were collected at first day of admission and SScs were calculated. The primary endpoint was re-hospitalization within the first 3 months.
Results: At baseline, the mean age was 62.1 years, LVEF was 29(6) %, NT-proBNP level was 2830 pg/mL. Twenty-one re-hospitalizations were observed due to HF. Patients who were re-hospitalized had significantly higher SScs than those who were not (5.6 vs.3.3 P= 0.01). Cox regression analysis demonstrated that the SSc was an independent predictor of re-hospitalization rate (HR, 1.12; 95% CI, 0.95–1.34; P=0.04). Roc curve analysis showed that SSc was predictive for rehospitalization with a cut-off value 4.3, with a sensitivity of 65% and a specificity of 49% (AUC 0.618, P=0.02). Our analysis indicated a positive correlation between SSc with NT-proBNP and a negative correlation between SSc and LVEF (respectively r=0.33, P=0.03 and r =-0.67, P=0.04).
Conclusion: Our results suggest that baseline SSc can be used as a predictor of re-hospitalization due to ischemic HF.

Anahtar Kelimeler

Heart failure, Re-hospitalization,, The Selvester QRS Score

Teşekkür

We would like to thank our valuable colleagues, Şifa Kaya and Gökhan Kafa, for their support.

İskemik kalp yetmezliği olan hastalarda tekrar hastaneye yatış için Selvester QRS skorunun prognostik değeri

Öz

Amaç: 12 derivasyonlu elektrokardiyogramda Selvester QRS skorunun miyokardiyal skarla ilgili çeşitli kardiyak olaylardaki prognostik etkileri bilinmektedir. Ayrıca, Selvester QRS skor sisteminin otopsi ile ölçülen miyokardiyal skar boyutu ile de yüksek derecede korelasyona sahip gösterilmiştir. Bu çalışmada, Selvester QRS skorunun iskemik kalp yetmezliğine bağlı yeniden hastaneye yatışı öngörmedeki rolünü değerlendirmeyi amaçladık.
Yöntemler: İskemik kalp yetmezliği olan elli dört hastanın verileri geriye dönük olarak incelendi. Hastaneye başvuru sırasındaki EKG’ler temel alınarak Selvester QRS skorları hesaplandı. Birincil son nokta, ilk 3 ay içindeki yeniden hastaneye yatış kabul edildi.
Bulgular: Çalışma popülasyonunda, ortalama yaşın 62,1 yıl, sol ventrikül ejeksiyon fraksiyonun (LVEF) %29(6), plazma beyin natriüretik peptit seviyesin (NT-proBNP) 2830 pg / mL olduğu görüldü. Çalışma boyunca 21 hastaneye yeniden yatış gözlendi. Yeniden hastaneye yatırılan hasta grubunda Selvester skoru, diğer gruba göre anlamlı olarak daha yüksekti (5,6'ya karşı 3,3 P=0,01). Cox orantısal risk regresyon analizi, Selvester QRS skorunun yeniden hastaneye yatış için bağımsız bir belirleyici olduğunu ortaya koydu (HR, 1.12; %95 güven aralığı, 0,95-1,34; P=0,04). En iyi cut-off değeri %65 duyarlılık ve %49 özgüllük ile 4,3 puan olarak belirlendi (eğri altındaki alan, 0,618, P=0,02). Ayrıca Selvester QRS skoru ile NT-proBNP arasında anlamlı pozitif korelasyon (r=0,33, P=0,03) ve Selvester QRS skoru ile LVEF arasında negatif korelasyon saptandı (r=-0,67, P=0,04).
Sonuç: Bulgularımız, başvuru anındaki Selvester QRS skorunun iskemik kalp yetmezliğine bağlı yeniden hastaneye yatışın bir öngörücü olarak kullanılabileceğini düşündürmektedir.

Anahtar Kelimeler

Kalp yetersizliği, Yeniden hastaneye yatış, Selvester QRS Skoru

Kaynakça

• 1. Castelvecchio S, Pappalardo OA, Menicanti L. Myocardial reconstruction in ischaemic cardiomyopathy. Eur J Cardiothorac Surg. 2019 Jun 1;55(Suppl 1):i49-i56. doi: 10.1093/ejcts/ezy367. PMID: 31106339; PMCID: PMC6526097.
• 2. Rossignol P, Hernandez AF, Solomon SD, Zannad F. Heart failure drug treatment. Lancet. 2019 Mar 9;393(10175):1034-44. doi: 10.1016/S0140-6736(18)31808-7. PMID: 30860029.
• 3. Matusik PS, Bryll A, Matusik PT, Popiela TJ. Ischemic and non-ischemic patterns of late gadolinium enhancement in heart failure with reduced ejection fraction. Cardiol J. 2020 Feb 10. doi: 10.5603/CJ.a2020.0009. Epub ahead of print. PMID: 32037500.
• 4. Markendorf S, Benz DC, Messerli M, Grossmann M, Giannopoulos AA, Patriki D, et al. Value of 12-lead electrocardiogram to predict myocardial scar on FDG PET in heart failure patients. J Nucl Cardiol. 2019 Aug 9. doi: 10.1007/s12350-019-01841-6. Epub ahead of print. PMID: 31399902.
• 5. Selvester RH, Wagner GS, Hindman NB. The Selvester QRS scoring system for estimating myocardial infarct size: the development and application of the system. Archives of Internal Medicine. 1985;145(10):1877-81.
• 6. Wagner GS, Freye CJ, Palmeri ST, Roark SF, Stack NC, Ideker RE, et al. Evaluation of a QRS scoring system for estimating myocardial infarct size. I. Specificity and observer agreement. Circulation. 1982;65(2):342-7.
• 7. Tiller C, Reindl M, Reinstadler SJ, Holzknecht M, Schreinlechner M, Peherstorfer A, et al. Complete versus simplified Selvester QRS score for infarct severity assessment in ST-elevation myocardial infarction. BMC Cardiovascular Disorders. 2019;19(1):1-7.
• 8. Bignoto TC, Le Bihan D, de Mattos Barretto RB, de Oliveira Ramos AI, Moreira DAR, Simonato M, et al. Predictive role of Selvester QRS score in patients undergoing transcatheter aortic valve replacement. Catheter Cardiovasc Interv. 2020 Apr 16. doi: 10.1002/ccd.28905.
• 9. Hiraiwa H, Okumura T, Sawamura A, Sugiura Y, Kondo T, Watanabe N, et al. The Selvester QRS score as a predictor of cardiac events in nonischemic dilated cardiomyopathy. Journal of Cardiology. 2018;71(3):284-90.
• 10. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats A, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. European heart journal. 2016;37(27):2129-200.
• 11. Gouda P, Brown P, Rowe BH, McAlister FA, Ezekowitz JA. Insights into the importance of the electrocardiogram in patients with acute heart failure. European Journal of Heart Failure. 2016;18(8):1032-40.
• 12. Strauss DG, Selvester RH, Lima JA, Arheden H, Miller JM, Gerstenblith G, et al. ECG quantification of myocardial scar in cardiomyopathy patients with or without conduction defects: correlation with cardiac magnetic resonance and arrhythmogenesis. Circulation: Arrhythmia and Electrophysiology. 2008;1(5):327-36.
• 13. Hiraiwa H, Okumura T, Sawamura A, Sugiura Y, Kondo T, Watanabe N, et al. The Selvester QRS score as a predictor of cardiac events in nonischemic dilated cardiomyopathy. Journal of Cardiology. 2018;71(3):284-90.
• 14. Wieslander B, Loring Z, Zareba W, McNitt S, Wagner GS, Daubert JP, et al. Scar burden assessed by Selvester QRS score predicts prognosis, not CRT clinical benefit in preventing heart failure event and death: A MADIT-CRT sub-study. Journal of Electrocardiology. 2016;49(4):603-9.
• 15. Strauss DG, Poole JE, Wagner GS, Selvester RH, Miller JM, Anderson J, et al. An ECG index of myocardial scar enhances prediction of defibrillator shocks: an analysis of the Sudden Cardiac Death in Heart Failure Trial. Heart Rhythm. 2011;8(1):38-45.