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[Long-term follow-up of electrocardiographic changes in patients with asymmetric apical hypertrophy]
T Nakamura1, K Furukawa, K Matsubara
1Second Department of Medicine, Kyoto Prefectural University of Medicine.
Insights
Asymmetric apical hypertrophy (AAH) patients show distinct electrocardiogram (ECG) changes over time. These changes correlate with cardiac symptoms and left ventricular (LV) wall abnormalities, impacting patient prognosis.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Cardiac Electrophysiology
Background:
- Asymmetric apical hypertrophy (AAH) is a form of left ventricular hypertrophy.
- Serial electrocardiographic (ECG) changes in AAH patients are not well-characterized.
- Understanding ECG evolution is crucial for assessing AAH progression and prognosis.
Purpose of the Study:
- To retrospectively review serial ECG changes in patients with AAH.
- To correlate ECG findings with clinical symptoms, echocardiography, and scintigraphy.
- To evaluate the prognostic significance of different ECG patterns in AAH.
Main Methods:
- Retrospective analysis of ECG, clinical data, echocardiography, and thallium-201 scintigraphy in 20 AAH patients.
- Patients were followed for 4-18 years (mean 8 years).
- ECG changes were categorized into distinct patterns based on R wave amplitude and T wave inversion.
Main Results:
- Two main ECG patterns emerged: Group I (stable/increasing R wave amplitude) and Group II (decreasing R wave amplitude, developing abnormalities).
- Group II patients exhibited more severe symptoms (palpitations, chest pain, dyspnea), spade-like LV deformity, and paradoxical apical flow on Doppler.
- Apical wall thickness was greater in Group II, and thallium-201 scintigraphy revealed apical hypoperfusion in some Group II patients.
Conclusions:
- Serial ECG changes in AAH can be categorized into distinct patterns.
- Progressive ECG abnormalities, particularly decreasing R wave amplitude, are associated with increased cardiac symptoms and LV structural changes.
- These findings highlight the importance of serial ECG monitoring for evaluating AAH progression and patient outcomes.
Abstract:
The serial electrocardiographic (ECG) changes of 20 patients with asymmetric apical hypertrophy (AAH) were retrospectively reviewed relative to their clinical symptoms, echocardiography and Doppler echocardiography, and thallium-201 perfusion scintigraphy. These patients were followed 4-18 years (mean 8 years). Patterns of the serial ECG changes were as follows: Seven patients (group Ia) had an increase of 10 mm or greater in the highest R wave amplitude in the precordial leads, with newly-developed giant T wave inversion. Five patients (group Ib) had relatively stable ECGs and the changes in the R wave amplitudes of less than 10 mm. Six patients (group IIa) had a decrease of 10 mm or greater in the highest R wave amplitude with mild decreases of negative T wave amplitudes. In the remaining two patients (group IIb) right bundle branch block developed. At the last follow-up study, group IIa had lower R wave amplitudes and longer QTc than did those in group I. The follow-up periods and their mean age did not differ among the groups. At the initial evaluation, exercise limitation was rare in group I; whereas, most of the patients in group II presented symptoms such as palpitation, chest pain or exertional dyspnea. These cardiac symptoms developed slowly but progressively during the follow-up period, and their incidence increased both in groups I and II at the final observation. Left ventricular (LV) wall thickness at the chordal level showed normal values and did not differ between the two groups, but apical wall thickness was greater in group II than in group I. Two-dimensional echocardiography showed a spade-like deformity of the LV in group II. In group I, the LV deformity was less marked and was not noted at the initial examination. Color Doppler echocardiography frequently revealed "paradoxical flow" expelled from the obliterated apex to the base in the early diastolic filling period in group II. Left ventriculography confirmed asynchronous contraction, hyperkinesis in the basal segment and dyskinesis at the apical segment, resulting in this abnormal intraventricular blood flow profiles. Serial studies by thallium-201 (TL) perfusion scintigraphy disclosed that four of the eight patients in group II developed localized hypoperfusion at the apex where a high and homogeneous uptake of TL was previously noted.(ABSTRACT TRUNCATED AT 400 WORDS)