Hypertrophic cardiomyopathy: two-dimensional echocardiographic score versus clinical and electrocardiographic findings
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P Melacini1, G Fasoli, B Canciani
1Department of Cardiology, University of Padua, Italy.
Insights
The severity of left ventricular hypertrophy in hypertrophic cardiomyopathy (HCM) correlates with ventricular arrhythmias. Echocardiographic scores did not correlate with symptoms or ECG abnormalities in HCM patients.
Area of Science:
- Cardiology
- Medical Imaging
- Cardiac Electrophysiology
Background:
- Hypertrophic cardiomyopathy (HCM) is characterized by left ventricular hypertrophy.
- The extent and location of hypertrophy influence clinical presentation and disease progression.
- Understanding the relationship between hypertrophy severity and arrhythmias is crucial for patient management.
Purpose of the Study:
- To evaluate left ventricular hypertrophy using echocardiographic scores.
- To correlate hypertrophy severity with clinical symptoms, electrocardiographic data, and ventricular arrhythmias in HCM patients.
Main Methods:
- Studied 42 patients with HCM using clinical examination, ECG, VCG, M-mode, and 2D echocardiography.
- Assessed hypertrophy severity with a scoring system (HS) and hypertrophy score index (HSI).
- Utilized 24-hour Holter monitoring for ventricular arrhythmia assessment.
Main Results:
- No significant correlation found between hypertrophy scores (HS, HSI) and patient symptoms.
- No significant correlation found between hypertrophy scores (HS, HSI) and ECG-VCG abnormalities.
- A statistically significant relationship (p < 0.01) was observed between hypertrophy severity and the occurrence of ventricular arrhythmias.
Conclusions:
- Hypertrophy severity in HCM, assessed by echocardiography, is significantly linked to ventricular arrhythmias.
- High intraventricular pressures in severe, diffuse hypertrophy may contribute to myocardial ischemia and tachyarrhythmias.
- Echocardiographic assessment of hypertrophy severity is valuable for predicting arrhythmia risk in HCM.
Abstract:
The severity and site of hypertrophy is important in determining the clinical picture and the natural history of hypertrophic cardiomyopathy (HCM). We evaluated left ventricular hypertrophy by means of two-dimensional echocardiographic score and score index, and correlated these findings with symptoms, electrovector-cardiographic data, and ventricular arrhythmias. A total of 42 patients with HCM were studied by clinical examination, ECG, VCG, M-mode and 2D echocardiography, and 24-h Holter monitoring. The extent and severity of the hypertrophic process were calculated by a score system. The left ventricle was divided into 11 segments and a hypertrophic score (HS) was given to each segment. A hypertrophy score index (HSI) was also calculated by dividing the number of hypertrophied segments by 13. No correlation was found between symptoms and HS and HSI, nor ECG-VCG abnormalities and HS and HSI. A statistically significant relationship between the severity of ventricular arrhythmias and HS and HSI was found (p less than 0.01). The mechanism responsible for ventricular tachyarrhythmias in severe and diffuse hypertrophy might reside in the high intraventricular pressures which produce or worsen areas of myocardial ischemia.