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Published on: December 11, 2017
Electrocardiographic-Based Assessment in Acute Heart Failure with Left Bundle Branch Block: Insights from a
Cuma Suleymanoğlu1, Fuat Polat2, Rıdvan Yurt3
1Department of Cardiology, Osmaniye State Hospital, Osmaniye, Turkey.
Insights
The Selvester QRS score (SQS) effectively identifies reduced left ventricular systolic function in acute heart failure patients with left bundle branch block. An SQS >43 offers moderate accuracy for risk stratification when echocardiography is delayed.
Area of Science:
- Cardiology
- Medical Imaging
- Electrocardiography
Background:
- Left bundle branch block (LBBB) complicates electrocardiogram (ECG) interpretation in acute heart failure (AHF).
- Evaluating ECG parameters against echocardiographic findings is crucial for understanding heart failure phenotypes in LBBB patients.
Purpose of the Study:
- To assess the relationship between ECG parameters (QRS duration, morphology, Selvester QRS score) and echocardiographic findings in AHF patients with LBBB.
- To determine the diagnostic performance of ECG indices in identifying reduced left ventricular systolic function across heart failure phenotypes.
Main Methods:
- Retrospective analysis of 275 hospitalized AHF patients with LBBB.
- Classification into heart failure with reduced (HFrEF), mildly reduced (HFmrEF), and preserved ejection fraction (HFpEF) based on LVEF.
- Correlation and multivariable regression analyses for ECG-echocardiographic associations; ROC analysis for diagnostic performance.
Main Results:
- The Selvester QRS score (SQS) significantly correlated with LVEF, LVEDD, LVESD, and LV mass index (all p<0.001).
- SQS and LV mass index independently predicted HFrEF in multivariable analysis (p<0.001).
- SQS demonstrated moderate discriminatory ability for reduced systolic function (AUC=0.768), with an optimal cutoff >43 (74.5% sensitivity, 69.6% specificity). QRS duration/morphology showed no predictive value.
Conclusions:
- In AHF patients with LBBB, SQS is superior to conventional QRS metrics for identifying reduced left ventricular systolic function.
- An SQS cutoff >43 provides moderate diagnostic accuracy and aids early risk stratification when echocardiography is unavailable.
Introduction:
Left bundle branch block (LBBB) complicates electrocardiographic interpretation in acute heart failure (AHF). This study aimed to evaluate the relationship between electrocardiographic parameters, including QRS duration, QRS morphology, and the Selvester QRS score (SQS), and echocardiographic findings in patients with AHF presenting with LBBB across different heart failure phenotypes.
Methods:
In this retrospective cohort, 275 patients hospitalized with AHF and LBBB were analyzed. Patients were classified as heart failure with reduced ejection fraction (HFrEF, left ventricular ejection fraction [LVEF] <40%), heart failure with mildly reduced ejection fraction (HFmrEF, LVEF 40-49%), or heart failure with preserved ejection fraction (HFpEF, LVEF ≥50%). Associations between electrocardiographic (ECG) and echocardiographic parameters were evaluated using Spearman correlation and multivariable regression. Discriminatory performance for reduced systolic function was assessed by receiver operating characteristic (ROC) analysis.
Results:
Mean age was 61.7 ± 13.8 years and 70.5% were male; median LVEF was 40% (IQR: 27-48%). HFrEF was present in 49.8%. Among ECG indices, only SQS correlated significantly with echocardiographic measures: LVEF (r = -0.447), left ventricular end-diastolic diameter (LVEDD, r = 0.346), left ventricular end-systolic diameter (LVESD, r = 0.373), and LV mass index (r = 0.205) (all p < 0.001). In multivariable analysis, SQS (OR = 1.373, 95% CI: 1.255-1.501, p < 0.001) and LV mass index independently predicted HFrEF. The Hosmer-Lemeshow test confirmed adequate calibration (p = 0.49). ROC analysis showed SQS had moderate discriminatory ability (area under the curve [AUC] 0.768, 95% CI: 0.711-0.825), with an optimal cutoff >43 yielding 74.5% sensitivity and 69.6% specificity. QRS duration and morphology demonstrated no meaningful predictive value (AUC ≈ 0.49).
Conclusion:
In AHF patients with LBBB, SQS outperforms conventional QRS metrics in identifying reduced LV systolic function. An SQS >43 provides moderate diagnostic accuracy and may support early risk stratification when echocardiography is not immediately available.
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