Simplified versus complete selvester QRS scoring system for scar assessment in hypertrophic cardiomyopathy patients
N Charoenpoonsiri, S Panthong, W Laohavinij, R Chokesuwattanaskul, V RungpradubvongAbstract
Background
Myocardial scar detected by late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) is a critical marker for predicting adverse outcomes in patients with hypertrophic cardiomyopathy (HCM). According to 2023 ESC Guidelines for the management of cardiomyopathies, an extensive LGE burden of ≥15% is associated with a significantly higher risk of sudden cardiac death, potentially serving as a Class IIb indication for prophylactic ICD implantation. While the complete Selvester QRS score offers a noninvasive electrocardiographic method to estimate myocardial scar, its complexity often limits routine clinical use. A simplified version was developed to improve feasibility, but its performance in patients with HCM remains uncertain.
Objectives
To compare the diagnostic performance of the complete and simplified Selvester QRS scoring systems for detecting myocardial scar and extensive scar burden in patients with HCM, using LGE-CMR as the reference standard.
Methods
This retrospective cross-sectional study included 144 patients with HCM who underwent both 12-lead electrocardiography and LGE-CMR between January 2015 and September 2024. Myocardial scar was defined as any LGE (>0% of left ventricular mass), and extensive scar as LGE ≥15%. Complete and simplified Selvester QRS scores were independently calculated by two blinded cardiology fellows. Diagnostic performance was assessed using receiver operating characteristic (ROC) curve analysis, with comparisons performed using DeLong’s test. Optimal cutpoints were determined by Youden’s index. LGE was present in 127 patients (88%). Both complete and simplified Selvester scores increased stepwise with greater scar burden. For detecting any myocardial scar, the simplified Selvester score demonstrated an area under the curve (AUC) of 0.66 (95% CI 0.52–0.79), compared with 0.63 (95% CI 0.49–0.77) for the complete score (p = 0.37). For detecting extensive scar (≥15%), both scores showed comparable performance (AUC 0.63 for each; p = 0.78). The optimal simplified Selvester cutpoint was ≥2 for detecting any scar (sensitivity 70.0%, specificity 66.7%) and ≥3 for detecting extensive scar (sensitivity 64.6%, specificity 70.5%).
Conclusions
In patients with HCM, both complete and simplified Selvester QRS scores demonstrate modest and comparable ability to detect myocardial scar on LGE-CMR. The simplified Selvester score offers similar diagnostic performance with greater clinical practicality. While guidelines recommend CMR for risk stratification in HCM, the simplified Selvester score serves as a pragmatic triage tool. By identifying extensive scar burden—a key indicator for ICD therapy—this ECG-based method helps clinicians prioritize high-risk patients when CMR access is limited or delayed.Extensive myocardial scar more than 15%Any myocardial scar