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

Bazoukis, George, Garcia-Zamora, Sebastian, Çinier, Göksel, Lee, Sharen, Gul, Enes Elvin, Álvarez-García, Jesús, Miana, Gabi, Hayıroğlu, Mert İlker, Tse, Gary, Liu, Tong, and others. (2022) Association of electrocardiographic markers with myocardial fibrosis as assessed by cardiac magnetic resonance in different clinical settings. World Journal of Cardiology, 14 (9). pp. 483-495. ISSN 1949-8462. (doi:10.4330/wjc.v14.i9.483) (KAR id:99767)



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


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


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) (


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.


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.

Item Type: Article
DOI/Identification number: 10.4330/wjc.v14.i9.483
Uncontrolled keywords: myocardial fibrosis, late gadolinium enhancement, electrocardiogram, cardiac magnetic resonance
Subjects: R Medicine
Divisions: Divisions > Division of Natural Sciences > Kent and Medway Medical School
Funders: University of Kent (
Depositing User: Gary Tse
Date Deposited: 30 Jan 2023 12:10 UTC
Last Modified: 31 Jan 2023 10:23 UTC
Resource URI: (The current URI for this page, for reference purposes)

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