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

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)


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) ( 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.

Original languageEnglish
Pages (from-to)483-495
Number of pages13
JournalWorld Journal of Cardiology
Issue number9
Publication statusPublished - 26 Sept 2022
Externally publishedYes


  • Cardiac magnetic resonance
  • Electrocardiogram
  • Late gadolinium enhancement
  • Myocardial fibrosis


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