Specificity for each of the 46 criteria of the Selvester QRS score for electrocardiographic myocardial scar sizing in left bundle branch block

Evaluation of the ECG based Selvester scoring method to estimate myocardial scar burden and predict clinical outcome in patients with left bundle branch block, with comparison to late gadolinium enhancement CMR imaging

“…At present a set of 46 criteria are used to characterize the myocardial scar tissue. It is possible that a more accurate score could be obtained if some of the less specific criteria of the score (46 in total) were omitted or modified, for instance R-wave amplitude and duration cutoffs and the potential error due to left axis deviation, both yielding erroneous Selvester score (Akerlund et al, 2015;Wieslander et al, 2015). Ideally this validation should be done in a larger multicentre cohort with high quality CMR data available.…”

“…Though promising, the limiting factor is the variable and at times low specificity for the 46 individual criteria assessed in the new semiautomatic Selvester LBBB version. Therefore, caution of its use has been advocated (Akerlund et al, 2015;Wieslander, Atwater, Wagner, & Ugander, 2015). The usability and prognostic significance of the Selvester score for patients with conduction abnormalities such as LBBB have yet to be extensively validated in patient materials (Wieslander et al, 2013).…”

Low lead one ratio predicts clinical outcomes in left bundle branch block

“…The present study used patient data from two centers to determine the optimal LOR threshold value for clinical use and validated its association with the likelihood of developing severe heart failure requiring advanced therapies or death. The LOR was chosen after a separate analysis and found that the lead one R/S ratio predicted LV scar and LV dysfunction better than the complete LBBB modified Selvester QRS score; a tool that has been shown to carry prognostic information but has limited association with scar presence and extent in patients with LBBB . The goal was to determine if a simple ECG criterion that can be assessed in real time while caring for a patient with LBBB could provide important information about the likelihood of LV dysfunction and adverse outcomes.…”

Cardiac resynchronization therapy: Identifying an activation delay by regional strain analysis

“…A high concordance between the presence of a typical LBBB contraction pattern and new more strict ECG criteria for LBBB was recently demonstrated in support of a close association between electrical activation and mechanical contraction. This may even be further improved with appropriate inclusion of scar quantification by Selvester criteria as addressed by Xia et al [19] and Akerlund et al [20] in the current issue of JECG.…”