ECG myocardial scar quantification predicts reverse left ventricular remodeling and survival after cardiac resynchronization therapy implantation: A retrospective pilot study

•Left ventricular scar burden by late gadolinium enhancement cardiac magnetic resonance imaging has been associated with outcomes after cardiac resynchronization therapy in previous studies.•We found that electrocardiographic scar burden identified using the modified Selvester method predicts left ventricular remodeling and mortality after cardiac resynchronization therapy implantation in patients with left bundle branch block.

IntroductionElectrocardiographic (ECG) LV scar quantification may improve prediction of CRT response.Methods and resultsData were abstracted in 76 patients who underwent a first CRT implantation at 2 US centers. Selvester QRS scar quantification was performed using the LBBB modified QRS scoring method. Seven clinical variables previously associated with reverse LV remodeling (RLVR) and QRS score were included in logistic regression analysis. Survival was compared across QRS score quartiles using Kaplan-Meier curves. RLVR occurred more frequently in patients with QRS score ≤ 5 (63%) than QRS score > 5 (22%), (OR = 5.83, 95% CI = 2.11-16.07). After adjustment for clinical variables using logistic regression, QRS score > 5 predicted RLVR (Chi-square = 20.3, P = 0.005, AUC = 0.782). Patients in the lowest quartile of QRS score (< 4) had improved survival compared to patients in the other QRS score quartiles (P = 0.037).ConclusionECG quantified LV scar predicts RLVR and long-term survival in patients with LBBB undergoing CRT implantation.