The ability of the electrocardiogram in left bundle branch block to detect myocardial scar determined by cardiovascular magnetic resonance

Björn Wieslander, Xiaojuan Xia, Robert Jablonowski, Jimmy Axelsson, Igor Klem, Robin Nijveldt, Charles Maynard, Erik B. Schelbert, Peder Sörensson, Andreas Sigfridsson, Uzma Chaudhry, Pyotr G. Platonov, Rasmus Borgquist, Henrik Engblom, Jean-Philippe Couderc, David G. Strauss, Brett D. Atwater, Martin Ugander

Research output: Contribution to journalArticleAcademicpeer-review


Aims: We aimed to improve the electrocardiographic 2009 left bundle branch block (LBBB) Selvester QRS score (2009 LBSS) for scar assessment. Methods: We retrospectively identified 325 LBBB patients with available ECG and cardiovascular magnetic resonance imaging (CMR) with late gadolinium enhancement from four centers (142 [44%] with CMR scar). Forty-four semi-automatically measured ECG variables pre-selected based on the 2009 LBSS yielded one multivariable model for scar detection and another for scar quantification. Results: The 2009 LBSS achieved an area under the curve (AUC) of 0.60 (95% confidence interval 0.54–0.66) for scar detection, and R2 = 0.04, p < 0.001, for scar quantification. Multivariable modeling improved scar detection to AUC 0.72 (0.66–0.77) and scar quantification to R2 = 0.21, p < 0.001. Conclusions: The 2009 LBSS detects and quantifies myocardial scar with poor accuracy. Improved models with extensive comparison of ECG and CMR had modest performance, indicating limited room for improvement of the 2009 LBSS.
Original languageEnglish
Pages (from-to)779-786
JournalJournal of Electrocardiology
Issue number5
Publication statusPublished - 2018

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