The complete QRS scoring system, or Selvester Score, is an expansion of the original QRS scoring system (with some of the same authors). While more complex, it provides improved accuracy for the estimation of infarct size. This can be used to estimate the total percentage of the left ventricle that is infarcted.
Limitations of the original, "simplified" score:
(1) Criteria covered only 87% of left ventricular myocardial infarctions.
(2) Relative under-representation of the posterolateral and basal regions.
(3) Notching of the QRS complex were not included.
|
|
Original Score |
Complete Score |
|---|---|---|
|
items |
29 |
54 |
|
maximum points |
29 |
32 |
Complete Scoring System
Requirements for accurate scoring:
(1) an adequate ECG recording
(2) rigorous definition of the various waveforms
(3) accurate measurement of the waveforms
|
Lead |
Criteria |
Points |
Maximum |
|---|---|---|---|
|
I |
Q >= 30 ms |
1 |
1 |
|
|
R/Q <= 1 R <= 0.2 mV |
1 1 |
1 |
|
II |
Q >= 40 ms Q >= 30 ms |
2 1 |
2 |
|
aVL |
Q >= 30 ms |
1 |
1 |
|
|
R/Q <= 1 |
1 |
1 |
|
aVF |
Q >= 50 ms Q >= 40 ms Q >= 30 ms |
3 2 1 |
3 |
|
|
R/Q <= 1 R/Q <= 2 |
2 1 |
2 |
|
V1 anterior |
any Q |
1 |
1 |
|
|
Q >= 1.8 mV, OR S >= 1.8 mV |
1 |
1 |
|
V1 posterior |
R/S >= 1 |
1 |
1 |
|
|
R >= 50 ms R >= 1.0 mV R >= 40 ms R >= 0.6 mV |
2 2 1 1 |
2 |
|
|
Q <= 0.3 mV AND S <= 0.3 mV |
1 |
1 |
|
V2 anterior |
any Q R <= 10 ms R <= 0.1 mV R <= R wave from V1 in mV |
1 1 1 1 |
1 |
|
V2 posterior |
R/S >= 1.5 |
1 |
1 |
|
|
R >= 60 ms R >= 2.0 mV R >= 50 ms R >= 1.5 mV |
2 2 1 1 |
2 |
|
|
Q <= 0.4 mV AND S <= 0.4 mV |
1 |
1 |
|
V3 |
any Q R <= 20 ms R <= 0.2 mV |
1 1 1 |
1 |
|
V4 |
Q >= 20 ms |
1 |
1 |
|
|
R/S <= 0.5 R/Q <= 0.5 R/S <= 1 R/Q <= 1 R <= 0.7 mV notched R wave |
2 2 1 1 1 1 |
2 |
|
V5 |
Q >= 30 ms |
1 |
1 |
|
|
R/S <= 1.0 R/Q <= 1.0 R/S <= 2 R/Q <= 2 R <= 0.7 mV notched R wave |
2 2 1 1 1 1 |
2 |
|
V6 |
Q >= 30 ms |
1 |
1 |
|
|
R/S <= 1.0 R/Q <= 1.0 R/S <= 3 R/Q <= 3 R <= 0.6 mV notched R wave |
2 2 1 1 1 1 |
2 |
where:
• A notched R wave is defined as a reversal of 0.05 mV or more within the initial 40 ms of the QRS complex.
• All ECGs used 3 channel and 12 leads, recorded with 10 mm per mV and 25 mm per second.
|
Leads |
Maximum Points |
|---|---|
|
I |
1 + 1 = 2 |
|
II |
2 |
|
aVL |
1 + 1 = 2 |
|
aVF |
3 + 2 = 5 |
|
V1 anterior |
1 + 1 = 2 |
|
V1 posterior |
1 + 2 + 1 = 4 |
|
V2 anterior |
1 |
|
V2 posterior |
1 + 2 + 1 = 4 |
|
V3 |
1 |
|
V4 |
1 + 2 = 3 |
|
V5 |
1 + 2 = 3 |
|
V6 |
1 + 2 = 3 |
|
total |
32 points |
complete score =
= SUM(points for all 12 leads)
Interpretation:
• minimum score: 0
• maximum score: 32
• Each point represents about 3% of the left ventricle (Wagner, page 165)
Limitations:
• 2 infarcts located in opposite sectors of the left ventricle may cancel each other out, causing the estimate of infarct size to be falsely low.
• Accuracy will be affected by the race, age and sex of the patient.
Purpose: To calculate the Selvester complete QRS score from the ECG after an acute myocardial infarction.
Specialty: Cardiology
ICD-10: I20, I21, I25, I70,
