Association of electrocardiographic markers with myocardial fibrosis as assessed by cardiac magnetic resonance in different clinical settings

George Bazoukis; Sebastian Garcia-Zamora; Göksel Çinier; Sharen Lee; Enes Elvin Gul; Jesús Álvarez-García; Gabi Miana; Mert İlker Hayıroğlu; Gary Tse; Tong Liu; Adrian Baranchuk

doi:10.4330/wjc.v14.i9.483

Association of electrocardiographic markers with myocardial fibrosis as assessed by cardiac magnetic resonance in different clinical settings

World J Cardiol. 2022 Sep 26;14(9):483-495. doi: 10.4330/wjc.v14.i9.483.

Authors

George Bazoukis^{1

2}, Sebastian Garcia-Zamora³, Göksel Çinier⁴, Sharen Lee⁵, Enes Elvin Gul⁶, Jesús Álvarez-García⁷, Gabi Miana⁸, Mert İlker Hayıroğlu⁴, Gary Tse^{9

10}, Tong Liu¹¹, Adrian Baranchuk¹²

Affiliations

¹ Department of Cardiology, Larnaca General Hospital, Larnaca 6036, Cyprus.
² Department of Basic and Clinical Sciences, University of Nicosia Medical School, Nicosia 2414, Cyprus. gbazoykis@yahoo.gr.
³ Department of Cardiology, Delta Clinic, Santa Fe 341, Argentina.
⁴ Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Center, Istanbul 34668, Turkey.
⁵ Cardiovascular Analytics Group, Laboratory of Cardiovascular Physiology, Hong Kong 999077, China.
⁶ Division of Cardiac Electrophysiology, Madinah Cardiac Centre, Madinah 42351, Saudi Arabia.
⁷ Department of Cardiology, Ramon y Cajal University Hospital, Madrid 28034, Spain.
⁸ Telehealth Center of Hospital das Clínicas, Hong Kong 999077, China.
⁹ Kent and Medway Medical School, Canterbury, Canterbury CT2 7FS, United Kingdom.
¹⁰ Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin, Tianjin Medical University, Tianjin 300211, China.
¹¹ Department of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China.
¹² Department of Cardiology, Queen's University, Ontario K7L 3N6, Canada.

Abstract

Background: Cardiac magnetic resonance (CMR) is a unique tool for non-invasive tissue characterization, especially for identifying fibrosis.

Aim: To present the existing data regarding the association of electrocardiographic (ECG) markers with myocardial fibrosis identified by CMR - late gadolinium enhancement (LGE).

Methods: A systematic search was performed for identifying the relevant studies in Medline and Cochrane databases through February 2021. In addition, we conducted a relevant search by Reference Citation Analysis (RCA) (https://www.referencecitationanalysis.com).

Results: A total of 32 studies were included. In hypertrophic cardiomyopathy (HCM), fragmented QRS (fQRS) is related to the presence and extent of myocardial fibrosis. fQRS and abnormal Q waves are associated with LGE in ischemic cardiomyopathy patients, while fQRS has also been related to fibrosis in myocarditis. Selvester score, abnormal Q waves, and notched QRS have also been associated with LGE. Repolarization abnormalities as reflected by increased Tp-Te, negative T-waves, and higher QT dispersion are related to myocardial fibrosis in HCM patients. In patients with Duchenne muscular dystrophy, a significant correlation between fQRS and the amount of myocardial fibrosis as assessed by LGE-CMR was observed. In atrial fibrillation patients, advanced inter-atrial block is defined as P-wave duration ≥ 120 ms, and biphasic morphology in inferior leads is related to left atrial fibrosis.

Conclusion: Myocardial fibrosis, a reliable marker of prognosis in a broad spectrum of cardiovascular diseases, can be easily understood with an easily applicable ECG. However, more data is needed on a specific disease basis to study the association of ECG markers and myocardial fibrosis as depicted by CMR.

Keywords: Cardiac magnetic resonance; Electrocardiogram; Late gadolinium enhancement; Myocardial fibrosis.