The QRS scoring system for estimating myocardial infarct size: clinical, angiographic and prognostic correlations

The relation between a QRS score derived from the routine electrocardiogram and left ventricular function was investigated in 181 patients after myocardial infarction. Patients with left ventricular hypertrophy and conduction defects were excluded. The QRS score correlated closely with the severity of wall motion abnormalities and left ventricular ejection fraction. The more severe the dyssynergy, the higher the QRS score (hypokinesia = 3.0; akinesia = 5.4; dyskinesia = 9.1). The left ventricular ejection fraction (percent) = 66 - (3.3 x QRS score) (correlation coefficient [r] = -0.81, probability [p] less than 0.001). With use of this regression equation, the QRS score predicted angiographic left ventricular ejection fraction to within 12% of the angiographic ejection fraction in 29 of 30 additional patients studied prospectively. The QRS score was also related to clinical functional class. The worse the clinical manifestation of left ventricular dysfunction, the higher the QRS score (Killip class I = 3.5; class II = 6.5; class III = 7.1). A QRS score greater than or equal to 7 had a specificity of 97% and a sensitivity of 59% for predicting an ejection fraction of less than 45%. Patients with a QRS score of 7 or greater had severe wall motion abnormalities, higher peak serum creatine kinase levels, higher prevalence of multivessel coronary disease, poor clinical functional class and an unfavorable outcome. The QRS score provides an inexpensive, clinically useful estimate of left ventricular function after myocardial infarction and can identify patients at high risk.

This article has been cited by other articles:

				D. G. Strauss, S. Cardoso, J. A. C. Lima, C. E. Rochitte, and K. C. Wu ECG scar quantification correlates with cardiac magnetic resonance scar size and prognostic factors in Chagas' disease Heart, March 1, 2011; 97(5): 357 - 361. [Abstract] [Full Text] [PDF]

				E. Bosimini, P. Giannuzzi, P. L. Temporelli, F. Gentile, D. Lucci, A. P. Maggioni, L. Tavazzi, L. Badano, I. Stoian, R. Piazza, et al. Electrocardiographic evolutionary changes and left ventricular remodeling after acute myocardial infarction: Results of the GISSI-3 Echo substudy J. Am. Coll. Cardiol., January 1, 2000; 35(1): 127 - 135. [Abstract] [Full Text] [PDF]

				R. L. Murkofsky, G. Dangas, J. A. Diamond, D. Mehta, A. Schaffer, and J. A. Ambrose A prolonged QRS duration on surface electrocardiogram is a specific indicator of left ventricular dysfunction J. Am. Coll. Cardiol., August 1, 1998; 32(2): 476 - 482. [Abstract] [Full Text] [PDF]

				R. J. Krone The Role of Risk Stratification in the Early Management of a Myocardial Infarction Ann Intern Med, February 1, 1992; 116(3): 223 - 237. [Abstract] [PDF]

				R. H. Selvester, G. S. Wagner, and N. B. Hindman The Selvester QRS Scoring System for Estimating Myocardial Infarct Size: The Development and Application of the System Arch Intern Med, October 1, 1985; 145(10): 1877 - 1881. [Abstract] [PDF]