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Electrocardiographic findings in patients with hypertrophic cardiomyopathy. Relation to presenting features and
F Pelliccia1, C Cianfrocca, R Cristofani
1Department of Cardiology, University of Rome, La Sapienza, Italy.
Insights
Electrocardiogram (ECG) findings in hypertrophic cardiomyopathy (HC) correlate with clinical presentation. Atrial fibrillation on ECG indicates worse prognosis and hemodynamic compromise in HC patients.
Area of Science:
- Cardiology
- Clinical Electrophysiology
Background:
- Hypertrophic cardiomyopathy (HC) is a complex cardiac condition.
- Understanding the relationship between electrocardiogram (ECG) findings and clinical features is crucial for prognosis.
Purpose of the Study:
- To evaluate the association of ECG abnormalities with presenting features and prognosis in patients with hypertrophic cardiomyopathy.
- To explore differences in ECG findings based on left ventricular outflow tract obstruction and age.
Main Methods:
- Retrospective analysis of ECGs from 125 consecutive hypertrophic cardiomyopathy patients.
- Comparison of ECG features across subgroups based on outflow tract gradient, age, and clinical functional status.
Main Results:
- Patients with outflow tract obstruction showed higher prevalence of left ventricular hypertrophy by ECG voltage criteria.
- Higher grade ventricular arrhythmias were more common in patients without an outflow gradient.
- Atrial fibrillation was significantly more prevalent in patients with moderate to severe functional limitation and associated with poorer hemodynamic status.
Conclusions:
- ECG findings in hypertrophic cardiomyopathy provide insights into clinical presentation and prognosis.
- Atrial fibrillation on ECG is a marker for advanced disease and impaired cardiac function in HC.
- Specific ECG abnormalities correlate with distinct clinical characteristics in HC patients.
Abstract:
The relation of ECG findings to presenting features and prognosis was evaluated in 125 consecutive patients with hypertrophic cardiomyopathy (HC). Seventy-nine men and 46 women (mean age, 34 +/- 7 years) were studied since 1970. Most ECG features were similar in patients with and without a left ventricular outflow tract gradient. Those with obstruction had a higher prevalence of left ventricular hypertrophy according to ECG voltage criteria (54% vs. 28%, p less than 0.01), whereas higher grade ventricular arrhythmias were more common in patients without an outflow gradient (20% vs. 7%, p less than 0.05). The prevalence of ECG abnormalities was also similar in younger (less than or equal to 14 years) and older patients (greater than 14 years), and only repolarization abnormalities were more frequently detected in the older age group (56% vs. 32%, p less than 0.025). Stratification of patients according to the clinical state revealed that those who had moderate to severe functional limitation had a higher prevalence of atrial fibrillation than asymptomatic or mildly symptomatic patients (24% vs. 1%, p less than 0.001). There were no significant differences in most hemodynamic variables among patients dichotomized according to any specific ECG abnormality. Only patients with atrial fibrillation had significantly higher right ventricular end-diastolic pressure (10 +/- 7 vs. 6 +/- 4 mmHg, p less than 0.01), lower systolic index (22 +/- 8 vs. 37 +/- 15 ml/m2; beat, p less than 0.02) and lower ejection fraction (53 +/- 8 vs. 64 +/- 10%, p less than 0.001) than those in sinus rhythm.(ABSTRACT TRUNCATED AT 250 WORDS)