1. VALIDATION OF ECG BASED QRS-SCORE TO PREDICT LEFT VENTRICULAR EJECTION FRACTION IN POST –MYOCARDIAL INFARCTION PATIENTS
Manish Jha,Anupam Singh,Jitendra Naik Rajendra Jha
Department of Medicine ,
RIMS,Ranchi `

2. Introduction
Many clinical methods have been developed for evaluation of size of myocardial infarct
ECG scoring systems have been developed to give objective clue regarding the same
These scores have been developed to give reliable estimates regarding ejection fraction post MI.

3. Palmeri QRS scoring system

4. Correlation of ECG score with Ejection fraction
These scores have been correlated with Left ventricular ejection fraction calculated by Echocardiography or radionuclide ventriculography
Original Pameri score correlates to LV ejection fraction with following equation
LVEF = 60- ( 3 X QRS score )

5. Lacunae in knowledge
Palmeri’s QRS score is a simple ECG score on basis of which ECG can be used to estimate Left Ventricular Ejection fraction ( LVEF) in addition to localisation of MI, thus helping in prognosis.
This score has not been validated as yet in India and it can be of tremendous advantage in India where It is not always possible to perform echocardiogram post MI due to resource crunch.

6. Materials and Methods
Aim: To validate Palmeri’s QRS score for estimating LVEF in patient’s admitted to a hospital based setting post MI.
Method: Prospective data from patients admitted with acute MI to inpatient service RIMS Ranchi was aken. Demographic variables,clinical history,vitals,ECG and Echocardiogram was done on each patient within threee days of admission, On basis of ECG palmeri’s QRS scoring ( based on Q waves,R/Q and R/S ration in ten ECG leads ) was done on each patient.

7. Materials and Methods
Echocardiography was done on each patient by an experienced operator blinded to results of ECG and localisation of MI was done and LVEF was calculated
Palmeri’s QRS score was compared against Ejection fraction calculated by Echo ( taken as Gold standard ) and sensitivity, specificity,Positive and Negative predictive values(PPV,NPV),Positive and Negative Likelihood ratio( PLR,NLR), Diagnostic Odds Ratio (DOR ),AUROC were calculated using ROC analysis on SPSS 15.0

8. Results
A cohort of 100 patients were prospectively studied :36 patients with extensive anterior MI, 27 persons with inferior wall MI,32 patients with antero-septal wall MI,4 patients with antero-inferior MI.and 1 patient with RVMI.
Patient with RVMI was excluded from final analysis. Palmeri’s QRS scoring was compared against Echo based LVEF by ROC analysis and its sensitivity, specificity PPV,NPV,PLR,NLR),DOR ,AUROC were calculated

9. Results
A regression analysis was done and Palmeri’s equation was modified LVEF= x QRS score ( R square=0.68) for best prediction.LVEF was highly correlated with Pameri’s QRS score ( r=0.8264,p<0.001)
Palmeri’s QRS scoring was compared against Echo based LVEF by ROC analysis and its sensitivity,specificityPPV,NPV,( PLR,NLR),DOR ,AUROC were as follows at best cut-off QRS score which came out to be > 5 in our study (94.74,78.75,51.4,98.4,4.46,0.07,637,0.955). The best cut off was 5 which discriminated between EF<40% and EF>40 % easily aompared to > 7 in palmeri’s study

10. Bland Altman Plot

11. Echo Palmeri score correlation

12. ROC curve

13. Conclusion
A new ECG based QRS score (Palmeri’s) score has been succesfully validated in Indian context where it had good discriminated power. It was also modified from original to adequately predict Ejection fraction in Indian context.