The Relationship Between Selvester QRS Score And Myocardial Fibrosis And Left Ventricular Structure And Function In Hypertrophic Cardiomyopathy

Part Ⅰ:The relationship between Selvester QRS score and myocardial fibrosis in hypertrophic cardiomyopathyObjective:Selvester QRS scoring system is an effective method to evaluate the amount of myocardial scar after myocardial infarction by using electrocardiographic index.Its value in evaluation of myocardial fibrosis and scar in hypertrophic cardiomyopathy(HCM)was still not clear.The aim of this study was to investigate the significance of Selvester QRS scoring system in evaluating myocardial fibrosis in HCM.Methods:149 HCM patients were enrolled in this study.The MRI-LGE(late gadolinium enhanced magnetic resonance imaging)was used to qualitatively and quantitatively analyze cardiac fibrosis(LGE score).The Selvester QRS score was calculated by standard 12-lead electrocardiogram.Correlation analysis was performed on Selvester QRS score and LGE score to evaluate the value of Selvester QRS score in assessing myocardial fibrosis in HCM.Results:In 149 patients,the Selvester QRS score was significantly associated with LGE score.The left ventricular scar size measured by the Selvester QRS score was 13.4 ± 11.4%,and 22.1±19.6%by using LGE,with the difference was 8.7%(95%CI:5.1-12.4%).The difference and consistency of the two methods were evaluated by Bland-Altman curve.When the myocardial fibrosis and scar area increased,the difference between the measured values of these two methods also increased accordingly.Multivariate regression analysis was used to identify the influencing factors of other variables and found that the Selvester QRS score and the maximum left ventricular wall thickness were independent predictors of presence of LGE.According to ROC curve analysis,Selvester QRS score≥3.5 or MWT≥21mm indicated a good predictive value for the presence of LGE.Conclusions:In HCM patients,the Selvester QRS electrocardiogram score was significantly associated with myocardial fibrosis(measured by MRI-LGE),and the total score>3.5 had a good predictive effect on the presence ofLGEPart Ⅱ:The relationship between Selvester QRS score and left ventricular structure and function in hypertrophic cardiomyopathyObjective:Many studies have shown that diastolic dysfunction is very common in hypertrophic cardiomyopathy(hypertrophic cardiomyopathy,HCM),which is closely related to myocardial fibrosis.The Selvester QRS score has a certain predictive significance for HCM myocardial fibrosis and scar.The aim of this study was to investigate the significance of Selvester QRS score in the assessment of diastolic dysfunction in HCM.Methods:60 HCM patients underwent echocardiography and tissue Doppler ultrasonography.Early diastolic peak inflow velocity(E),late diastolic peak inflow velocity(A),deceleration time of E(DT),E/A ratio,Early diastolic peakvelocity of mitral annular(Ea),late diastolic peak velocity of mitral annular(Aa),E/Ea ratio,isovolumic relaxation time(IVRT)and other indicators were measured.The Selvester QRS score was calculated by standard 12-lead electrocardiogram and the peripheral blood was collected to detect the fibrosis markers.The relationship between the Selvester QRS score and the ultrasonographic parameters reflecting HCM diastolic dysfunction and peripheral blood fibrosis markers were investigated.Results:Compared with the patients in the group of Selvester QRS score=0,patients in the group of Selvester QRS score>0 had thicker interventricular septum thickness(22.3 ± 5.10 mm vs 19.1 ± 4.18 mm,P = 0.043)and left maximum wall thickness(26.67± 4.80 mm vs 22.2±4.32mm,P=0.004),and slower lateral Ea(6.22 ± 2.47cm/s vs 10.5± 5.0cm/s,P = 0.009)and septal Ea(5.63 ± 2.38cm/s vs 8.03±2.91cm/s,P=0.003),but bigger lateral E/Ea(15.5 ± 5.70 vs 9.38 ± 3.16,P<0.001)and septal E/Ea(17.2 ± 5.45 vs 12.0 ± 3.43,P = 0.002)and higher PICP concentrations(170.8 ± 55.5 ng/ml vs 128.1 ± 53.6 ng/ml,P = 0.019).There was a significant positive correlation between Selveseter QRS score and the cTnI concentration(r =0.388,P = 0.002),interventricular septum thickness(r = 0.463,P<0.001),maximum wall thickness(r = 0.255,P = 0.001),LVOTG(r = 0.319,P = 0.013),lateral E/Ea(r=0.310,P = 0.016)and septal E/Ea(r = 0.429,P = 0.001).Multivariate regression analysis showed that the Selvester QRS score was an independent predictor of septal E/Ea in patients with HCM(beta = 0.482,P = 0.045),but not an independent predictor of lateral E/Ea(beta = 0.139,P(Beta = 0.032,P = 0.034).Procollagen type I N-terminal propeptide(PICP)and NYHA class(beta = 3.334,P = 0.014)were independent predictors of lateral E/Ea.Conclusions:The Selvester QRS score was significantly correlated with septal E/Ea and lateral E/Ea,and it was an independent factor influcing septal E/Ea in HCM,which suggested that Selvester QRS score could be used to evaluate diastolic dysfunction in HCM combined with other cardiac indices.