Electrocardiographic measurement of infarct size compared to cardiac MRI in reperfused first time ST-segment elevation myocardial infarction

Background Myocardial infarct size (IS) following ST-segment elevation myocardial infarction (STEMI) is an important prognostic factor. We assessed the Selvester 32-point QRS score from the 12-lead ECG for measurement of IS in STEMI patients receiving reperfusion therapy compared to cardiac magnetic resonance imaging (CMRI). Furthermore we sought to explore the impact of microvascular obstruction (MVO) on the scoring system, and determine factors contributing to discrepancies between CMRI IS and Selvester score. Methods We examined 70 patients (55 men, 15 women), mean age 57 ± 10 years with a first time STEMI (46 anterior, 24 non-anterior). QRS scores were calculated early and at follow-up (mean 2 ± 1 and 59 ± 14 days post-STEMI). Myocardial core scar size (5SD) was measured at 5.3 ± 3.3 and 57.8 ± 13.5 days post-infarction by CMRI. MVO was determined on initial MRI. Logistic regression analysis was performed to determine factors contributing to discordant scores, defined as a difference between CMRI and Selvester IS of > 6% myocardium. Results QRS scoring of anterior infarcts correlated with CMRI IS both early (r = 0.734, p < 0.0001) and at follow-up (r = 0.716, p < 0.0001); however no correlation was seen among non-anterior infarcts. QRS scoring overestimated IS at all time points. There was better agreement between ECG and CMRI measured IS in patients without MVO at both time points. Anterior infarction was inversely predictive of discordant IS estimation acutely, and larger Selvester scores were predictive of inaccurate scoring at both time periods. Conclusions Selvester QRS score correlates well with CMRI IS for anterior infarcts. MVO did not independently affect the score.