Comparison of Electrocardiography Markers and Speckle Tracking Echocardiography for Assessment of Left Ventricular Myocardial Scar Burden in Patients with Previous Myocardial Infarction

• Published in: The American journal of cardiology Vol. 119; no. 9; pp. 1307 - 1312
• Main Authors: Nestaas, Eirik, MD, Shih, Jhih-Yuan, MD, Smedsrud, Marit K., MD, Gjesdal, Ola, MD, Hopp, Einar, MD, Haugaa, Kristina H., MD, Edvardsen, Thor, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-05-2017; Elsevier Limited; Elsevier Science
• Subjects: Aged; Cardiac arrhythmia; Cardiovascular; Cardiovascular disease; Cicatrix - diagnostic imaging; Cicatrix - etiology; Cicatrix - physiopathology; Cohort Studies; Confidence intervals; Contrast Media; Echocardiography; EKG; Electrocardiography; Female; Gadolinium; Heart; Heart attacks; Heart diseases; Heart Ventricles - diagnostic imaging; Heart Ventricles - physiopathology; Humans; Magnetic resonance; Magnetic Resonance Imaging; Male; Markers; Middle Aged; Myocardial infarction; Myocardial Infarction - complications; NMR; Nuclear magnetic resonance; Patients; Prognosis; Quartiles; Scars; Sensitivity analysis; Software; Stroke Volume; Tracking; Ventricle; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - physiopathology; Electrocardiography; Magnetic Resonance Imaging; Myocardial Infarction; Echocardiography
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2017.01.020

Abstract Myocardial scar burden is an important prognostic factor after myocardial infarction. This cohort study compared assessment of left ventricle scar burden between pathological Q-waves on electrocardiography (ECG), Selvester multi-parametric ECG scoring system for scar burden and global longitudinal strain (GLS) by speckle tracking echocardiography 6 months after myocardial infarction. The scar burden was defined by late gadolinium enhancement cardiac magnetic resonance as fraction of total left ventricle tissue. ECG measures were presence of pathological Q-waves and Selvester scores. GLS was the average of peak strain from 16 left ventricle segments. In 34 patients age 58±10 years (mean±SD), the scar burden was 19 (9, 26)% (median (quartiles)) and 79% had scar burden >5%. Patients with scar burden >5% more frequently had pathological Q-waves (63% vs. 14%) and had worse Selvester scores (5 (3, 7) vs. 0 (0, 1)) and worse GLS (-16.6±2.4% vs. -19.9±1.1%). Pathological Q-waves, Selvester scores, ejection fraction and GLS related to scar burden in univariable analyses. Sensitivity and specificity for detecting scar burden >5% was 63% and 86% (pathological Q-waves), 89% and 86% (Selvester score), 81% and 86% (ejection fraction), 89% and 86% (GLS) and 96% and 71% (combination of Q-waves, Selvester score and GLS). In conclusion, Selvester score and GLS related to scars 6 months after myocardial infarction, pathological Q-waves were only weakly associated with scar and GLS was associated with scar independently of ECG markers.