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Correlation of the complete version of the Selvester QRS scoring system with quantitative anatomic findings for
D C Sevilla1, N B Wagner, R Pegues
1Department of Pathology, Duke University Medical Center, Durham, North Carolina 27710.
Insights
The Selvester QRS scoring system shows a significant correlation for estimating multiple myocardial infarct sizes. However, this correlation is weaker than for single infarcts, suggesting a need for QRS criteria modification.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- Previous studies reported correlations between QRS scoring and infarct size for single myocardial infarcts.
- Limited quantitative data exists on electrocardiographic estimation of total left ventricular infarction in patients with multiple infarcts.
Purpose of the Study:
- To quantitatively assess the correlation between QRS-estimated and anatomically documented myocardial infarct size in patients with multiple infarcts.
- To evaluate the effectiveness of the Selvester QRS scoring system in cases of multiple myocardial infarctions.
Main Methods:
- Retrospective analysis of 32 patients with anatomically documented multiple myocardial infarcts.
- Comparison of infarct size estimated by the Selvester QRS scoring system against pathoanatomic findings.
Main Results:
- A significant correlation (r = 0.44; p = 0.01) was found between QRS-estimated and anatomically documented infarct sizes in multiple infarct cases.
- This correlation was weaker than previously reported for single infarcts.
- Several QRS criteria were infrequently met, particularly those for posterior infarction, potentially due to a 'cancellation effect' from coexisting anterior infarcts.
Conclusions:
- The Selvester QRS scoring system demonstrates a significant but reduced ability to estimate total infarct size in patients with multiple myocardial infarcts.
- Existing QRS criteria may require modification to improve accuracy in complex infarction scenarios.
- Further research is needed to refine QRS criteria for enhanced estimation of myocardial infarct size in multiple infarct cases.
Abstract:
The correlation between myocardial infarct size estimated by the complete version of the Selvester QRS scoring system and that documented by pathoanatomic studies has been reported for single anterior, inferior and posterolateral infarcts. Although previous studies described electrocardiographic changes in patients with multiple infarcts, no quantitative documentation of the ability of such changes to estimate the total amount of left ventricular infarction has been reported. This study of 32 patients with anatomically documented multiple infarcts shows a significant correlation between QRS-estimated and anatomically documented sizes (r = 0.44; p = 0.01), which is less than that previously reported for single infarcts in the anterior, inferior and posterolateral locations. Several of the 54 electrocardiographic criteria were never satisfied. Criteria for posterior infarction were seldom present, suggesting "cancellation effect" of coexisting anterior infarction. These results will be the basis for future modification of QRS criteria for estimating myocardial infarct size.