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

doi:10.1111/anec.12264

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 journal › Article › peer-review

13 Scopus citations

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 of 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 ECG 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 (LPs) 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 language	English (US)
Pages (from-to)	49-59
Number of pages	11
Journal	Annals of Noninvasive Electrocardiology
Volume	21
Issue number	1
DOIs	https://doi.org/10.1111/anec.12264
State	Published - Jan 1 2016

Funding

NIH Cardiac Translational Research Implementation Program (CTRIP) P20 to Johns Hopkins Hospital, Joao Lima, M.D., Principal Investigator. Nathan Mewton was supported by a Postdoctoral Research Grant from the French Federation of Cardiology and also received support from the Leducq Foundation Alliance against Sudden Cardiac Death Network Award to Johns Hopkins University. The authors wish to express their sincere acknowledgements to Anita Bacher, Rosalie Cosgriff, Meredith Dobrosielski, and Jeanette Walker for their help on the screening, enrollment, and data collection of participants.

Funders	Funder number
Author National Institutes of Health National Institutes of Health National Institutes of Health National Institutes of Health The Bev Hartig Huntington's Disease Foundation National Institutes of Health	R01HL118277
National Institute of Health National Heart, Lung, and Blood Institute	P20HL101397
Johns Hopkins Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University
The Johns Hopkins Hospital
Fondation Leducq
Fédération Française de Cardiologie

Keywords

T-wave alternans
death, sudden
magnetic resonance imaging
myocardial scar
screening

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine
Physiology (medical)

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10.1111/anec.12264

Cite this

Mewton, N., Strauss, D. G., Rizzi, P., Verrier, R. L., Liu, C. Y., Tereshchenko, L. G., Nearing, B., Volpe, G. J., Marchlinski, F. E., Moxley, J., Killian, T., Wu, K. C., Spooner, P., & Lima, J. A. C. (2016). Screening for Cardiac Magnetic Resonance Scar Features by 12-Lead ECG, in Patients with Preserved Ejection Fraction. Annals of Noninvasive Electrocardiology, 21(1), 49-59. https://doi.org/10.1111/anec.12264

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 2016, 'Screening for Cardiac Magnetic Resonance Scar Features by 12-Lead ECG, in Patients with Preserved Ejection Fraction', Annals of Noninvasive Electrocardiology, vol. 21, no. 1, pp. 49-59. https://doi.org/10.1111/anec.12264

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

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 of 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 ECG 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 (LPs) 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 = "T-wave alternans, death, sudden, magnetic resonance imaging, myocardial scar, screening",

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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year = "2016",

month = jan,

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doi = "10.1111/anec.12264",

language = "English (US)",

volume = "21",

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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 - 2016/1/1

Y1 - 2016/1/1

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 of 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 ECG 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 (LPs) 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 of 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 ECG 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 (LPs) 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 - T-wave alternans

KW - death, sudden

KW - magnetic resonance imaging

KW - myocardial scar

KW - screening

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

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