Performance of 12‐lead electrocardiogram Selvester QRS scoring criteria to diagnose myocardial scar in patients with hypertrophic cardiomyopathy

BACKGROUND: The Selvester QRS score can identify the presence and extent of myocardial scar in ischemic and nonischemic cardiomyopathy, but its performance in patients with hypertrophic cardiomyopathy (HCM) has not been assessed. METHODS: Consecutive patients with HCM referred to our hospital between January 2012 and July 2016 were prospectively enrolled. All patients underwent cardiac magnetic resonance (CMR) and 12‐lead electrocardiography. The Selvester QRS score was used to evaluate the presence and extent of myocardial scarring, and the results were compared with that obtained with the gold standard—late gadolinium enhancement (LGE) on CMR. RESULTS: A total of 135 HCM patients were enrolled. LGE was present in 93 of 135 (69%) patients. The median LGE mass was 5 (0–14) g, and the median proportion of total left ventricular mass showing LGE was 4% (0%–10%). A total of 92 patients had Selvester score ≥1. The highest score recorded was 13; the median score was 1 (0–3). In receiver operating curve analysis, Selvester score ≥1 was identified as the optimum score for predicting presence of LGE enhancement; the area under the curve was 0.826 (95% CI, 0.752–0.900; p < .001). Significant positive correlation was seen between the Selvester score and the extent of LGE enhancement (Spearman ρ, .572; p < .001). The Selvester scoring system correctly identified all LGE segments in 13 of 93 (14%) patients and some LGE segments in 39 (41.9%) patients. CONCLUSIONS: The Selvester QRS score appears to be a convenient and reliable method to determine the presence and extent of myocardial scar in patients with HCM.