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Evolution of the electrocardiographic changes in patients with hypertrophic cardiomyopathy
M Tendera1, L Poloński, J Wodniecki
12nd Department of Cardiology, Silesian Medical Academy, Zabrze, Poland.
Insights
Electrocardiogram (EKG) changes in hypertrophic cardiomyopathy (HCM) often progress over time, particularly in younger patients with left ventricular outflow obstruction. This progression is linked to increased clinical deterioration, highlighting the need for long-term monitoring.
Area of Science:
- Cardiology
- Clinical Electrophysiology
Background:
- Hypertrophic cardiomyopathy (HCM) is a complex cardiac condition.
- Long-term electrocardiographic (EKG) evolution in HCM patients is not fully understood.
Purpose of the Study:
- To assess the progression of EKG abnormalities in a cohort of HCM patients over an extended follow-up period.
- To identify factors predisposing to EKG progression and its association with clinical outcomes.
Main Methods:
- Retrospective analysis of EKG data from 75 hypertrophic cardiomyopathy patients.
- Mean follow-up duration of 5.5 years (range 2-20 years).
- Assessment of EKG changes including QRS voltage, P-wave abnormalities, and Q waves.
Main Results:
- 47% of patients exhibited EKG progression.
- Progression rates increased with longer follow-up durations (27% >5 years, 41% 5-8 years, 80% >8 years).
- Younger age (<30) and left ventricular outflow obstruction were associated with progression within 5-8 years; progressive EKG changes correlated with clinical deterioration (63% vs. 15%).
Conclusions:
- Hypertrophic cardiomyopathy demonstrates significant EKG progression in a substantial proportion of adult patients during long-term follow-up.
- EKG progression is linked to adverse clinical outcomes.
- Verapamil showed a trend towards less EKG progression compared to propranolol.
Abstract:
In 75 patients with hypertrophic cardiomopathy (HCM) followed for a mean period of 5.5 years (range 2-20 years), evolution of the electrocardiographic (EKG) changes was assessed. Progression of EKG abnormalities occurred in 35 patients (47%). It was manifested by an increase in precordial QRS voltage in 33 patients, development of new P-wave mitral in 11 patients, and development or disappearance of pathologic Q waves in 14 patients. With follow-up times greater than 5 years, 5-8 years, and greater than 8 years, EKG progression was present in 27, 41, and 80% of patients, respectively. Age less than 30 years at the beginning of study and left ventricular outflow obstruction predisposed to EKG progression within 5-8 years. Patients with progressive EKG changes were more prone to experience clinical deterioration than those without EKG progression (63 vs. 15%, p less than 0.001). With chronic verapamil administration, progression of EKG abnormalities occurred insignificantly less often than with propranolol treatment (35 vs. 64%, p = 0.20). It is concluded that with long-term follow-up, HCM tends to progress in a significant proportion of adult patients.