Systematic Reviews
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Sep 26, 2022; 14(9): 483-495
Published online Sep 26, 2022. doi: 10.4330/wjc.v14.i9.483
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
George Bazoukis, Department of Cardiology, Larnaca General Hospital, Larnaca 6036, Cyprus
George Bazoukis, Department of Basic and Clinical Sciences, University of Nicosia Medical School, Nicosia 2414, Cyprus
Sebastian Garcia-Zamora, Department of Cardiology, Delta Clinic, Santa Fe 341, Argentina
Göksel Çinier, Mert İlker Hayıroğlu, Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Center, Istanbul 34668, Turkey
Sharen Lee, Cardiovascular Analytics Group, Laboratory of Cardiovascular Physiology, Hong Kong 999077, China
Enes Elvin Gul, Division of Cardiac Electrophysiology, Madinah Cardiac Centre, Madinah 42351, Saudi Arabia
Jesús Álvarez-García, Department of Cardiology, Ramon y Cajal University Hospital, Madrid 28034, Spain
Gabi Miana, Telehealth Center of Hospital das Clínicas, Hong Kong 999077, China
Gary Tse, Kent and Medway Medical School, Canterbury, Canterbury CT2 7FS, United Kingdom
Gary Tse, 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
Tong Liu, Department of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China
Adrian Baranchuk, Department of Cardiology, Queen's University, Ontario K7L 3N6, Canada
Author contributions: Bazoukis G had the inception of the idea and wrote the first draft; Bazoukis G and Garcia-Zamora S performed the systematic search; Bazoukis G, Garcia-Zamora S, Cinier G, Lee S, Gul EE, García JA, Miana G, Hayıroğlu MI, Tse G, Liu T, and Baranchuk A performed major revisions and approved the final manuscript; Baranchuk A supervised the study.
Conflict-of-interest statement: All authors declare no conflicts of interest.
PRISMA 2009 Checklist statement: All authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: George Bazoukis, MD, PhD, Doctor, Department of Cardiology, Larnaca General Hospital, Inomenon Polition Amerikis, Larnaca 6036, Cyprus. gbazoykis@yahoo.gr
Received: April 9, 2022
Peer-review started: April 9, 2022
First decision: May 31, 2022
Revised: May 31, 2022
Accepted: August 17, 2022
Article in press: August 17, 2022
Published online: September 26, 2022
Processing time: 163 Days and 10.9 Hours
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: Myocardial fibrosis; Late gadolinium enhancement; Electrocardiogram; Cardiac magnetic resonance

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