Selvester QRS score predicts improvement of LVEF in atrial fibrillation patients with systolic heart failure

Abstract

Background Left‐ventricular systolic dysfunction (LVSD) comorbid with atrial fibrillation is reversible, but recovery is limited in a subset of patients. The Selvester QRS (S‐QRS) score is an electrocardiogram‐based assessment that reportedly reflects myocardial scar/damage. We evaluated the predictability of S‐QRS score for the recovery of left‐ventricular ejection fraction (LVEF) in persistent AF (PeAF) patients with LVSD undergoing catheter ablation (CA). Method CA was performed in 51 PeAF patients with reduced LVEF (<40%); S‐QRS scores were measured after restoration of sinus rhythm. LVEF was re‐evaluated at one year after CA; LVEF recovery was related to the S‐QRS score. Results The median [interquartile range] S‐QRS score was 1 point [0–2]. LVEF increased from 32% [28–37] at baseline to 56% [49–57] at 1 year after CA. Thirty‐seven patients achieved normalization of LVEF (≥50%, Group A); 14 patients did not (Group B). Group A had significantly lower S‐QRS scores than Group B (0 point [0–2] vs. 2 points [2–3], p < .05). In univariate/multivariate analyses, S‐QRS score was an independent predictor of LVEF normalization. In the receiver operating characteristic curve, the cut‐off value of S‐QRS score was 2 points for prediction of the LVEF normalization (AUC = 0.79). Patients with low S‐QRS score (<2 points) had greater LVEF improvement than those with high S‐QRS score (≥2 points, ΔLVEF: 23% [17–28] vs. 17% [12–24], p < .05). Conclusion S‐QRS scoring noninvasively assesses the improvement of LVEF in PeAF patients with LVSD after CA. A high S‐QRS score may indicate underlying myocardial scar/damage associated with unknown etiologies for LVSD other than PeAF.

Relationship between the Selvester QRS Score and Coronary Microvascular Dysfunction Assessed by the Index of Microcirculatory Resistance

“…In the present study, the QRS score ≥3 group showed significantly higher IMR in comparison to the QRS 0-2 group. Selvester's QRS score reflects myocardial damage influenced by diverse factors, including previous MI, chronic atrial fibrillation, and heart failure ( 6 , 14 ). In this study, patients in the QRS score ≥3 group exhibited higher rates of previous MI, chronic atrial fibrillation, and higher NT-pro BNP in comparison to the QRS score 0-2 group.…”

“…We excluded patients with left or right bundle branch block, in line with other studies that excluded them due as the ECGs of these patients were not suitable for the analyses. Conversely, some investigations included them using their specific scoring criterion if the ECG was LBBB or RBBB type ( 13 , 14 ). We conducted a further analysis including patients with left or right bundle branch block employing each Selvester QRS score criterion.…”

“…3 group showed significantly higher IMR in comparison to the QRS 0-2 group. Selvester's QRS score reflects myocardial damage influenced by diverse factors, including previous MI, chronic atrial fibrillation, and heart failure (6,14). In this study, patients in the QRS score !…”

“…Each QRS type had specific scoring criteria and the score was individually calculated with each criterion excluding patients with LBBB or RBBB. The algorithms for categorization and the QRS score criterion were based on previous reports ( 11 - 14 ). Determination of the QRS score takes less than 5 minutes for a trained observer to complete per patient.…”

“…The bundle branch block was categorized into four subtypes: left bundle branch block (LBBB), left anterior fascicular block (LAFB), right bundle branch block (RBBB), and RBBB+LAFB type. QRS scores were calcu- (11)(12)(13)(14). Determination of the QRS score takes less than 5 minutes for a trained observer to complete per patient.…”