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Serial electrocardiographic and angiographic changes of patients with hypertrophic cardiomyopathy
1Second Department of Internal Medicine, School of Medicine, Kanazawa University, Japan.
Insights
Serial electrocardiogram (ECG) changes, particularly T wave alterations, correlate with myocardial changes in hypertrophic cardiomyopathy (HCM). ECG monitoring can assess wall thickness, left ventricular (LV) form, and LV function over time.
Area of Science:
- Cardiology
- Medical Imaging
- Biomedical Engineering
Background:
- Hypertrophic cardiomyopathy (HCM) involves significant myocardial changes.
- Long-term assessment of HCM progression requires correlating clinical findings with imaging data.
Purpose of the Study:
- To investigate the relationship between serial electrocardiogram (ECG) findings and myocardial alterations in patients with HCM.
- To compare ECG changes with left and bi-ventriculogram data over time.
Main Methods:
- 15 patients with HCM and no intraventricular conduction disturbance were studied.
- Serial ECGs were analyzed, focusing on T wave changes, and categorized into three groups.
- ECG findings were compared with serial left ventriculograms and bi-ventriculograms.
Main Results:
- Group A-1 (increased/new negative T waves) showed increased SV1+RV5, wall thickness, and decreased peak dV/dt/EDV, with a shift to a spade-like LV configuration.
- Group A-2 (decreased/resolved negative T waves) showed decreased SV1+RV5, wall thickness, and peak filling rates, with decreased ejection fraction (EF); 2 cases progressed to dilated cardiomyopathy.
- Group B (no significant T wave changes) showed stable SV1+RV5, wall thickness, and LV function.
Conclusions:
- Serial ECG observations are valuable for assessing dynamic changes in myocardial wall thickness.
- ECG monitoring can track alterations in left ventricular (LV) form and function in HCM patients.
- T wave evolution on ECG provides insights into the long-term course and potential progression of HCM.
Abstract:
The characteristics of ECG findings as they relate to myocardial changes during long-term course of hypertrophic cardiomyopathy (HCM) were studied. Serial changes in ECG were compared with changes left ventriculogram and bi-ventriculogram in 15 patients with HCM without intraventricular conduction disturbance. Serial changes in ECG findings, with special reference to the negative T wave, were categorized in three groups; 1) 5 patients with increase or appearance of the negative T wave (A-1 group). 2) 4 patients with decrease or disappearance of the negative T wave (A-2 group). 3) 6 patients without significant changes in the T wave (B-group). A-1 group presented a marked increase in SV1 + RV5, and of the thickness of anterior and apical wall, and a decrease of the peak dV/dt/EDV (end diastolic volume-normalized peak filling rate), serially. End diastolic volume (EDV) and ejection fraction (EF) did not change significantly. The configuration of left ventriculogram changed from a round form to a spade-like form. A-2 group presented a marked decrease in SV1 + RV5, the thickness of anterior and apical wall, peak dV/dt/EDV and peak dV/dt/V (left ventricular volume of the time of peak filling-normalized peak filling rote). EF decreased serially, 2 cases of A-2 group presented the clinical picture of dilated cardiomyopathy in the end stage. In B group, SV1 + RV5, the wall thickness and left ventricular function did not change, serially. In conclusion, serial observations of ECG are useful for assessing alterations in wall thickness, LV-form and LV-function.