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[Correlations between electrocardiographic findings and echocardiographic patterns in 116 patients with hypertrophic
Insights
Electrocardiography (ECG) and echocardiography effectively correlate in diagnosing hypertrophic cardiomyopathy (HCM). While ECG aids diagnosis, no single pattern is specific, and normal ECGs occur in HCM patients.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- Hypertrophic cardiomyopathy (HCM) is a complex cardiac condition.
- Accurate diagnosis relies on integrating various imaging and electrical assessment methods.
Purpose of the Study:
- To determine the correlation between electrocardiographic (ECG) and echocardiographic (E-TM, E-2D) findings in HCM patients.
- To assess the diagnostic utility of ECG patterns in different HCM morphological types.
Main Methods:
- 116 patients with HCM were evaluated using ECG, echocardiographic m-mode (E-TM), and two-dimensional (E-2D) echocardiography.
- Patients were classified into four types based on Maron et al's E-2D classification.
- Statistical analysis was performed to identify correlations and significant findings.
Main Results:
- 12% of patients had normal ECGs, often associated with E-2D types I-II and IIIb.
- Left ventricular hypertrophy on ECG was most frequent (46%) in E-2D type III.
- Abnormal Q waves (18%) and ST-T changes were found across morphologic types; giant negative T waves were linked to apical HCM.
- Left atrial dimensions did not predict atrial fibrillation.
Conclusions:
- ECG remains valuable for HCM diagnosis, despite the absence of a pathognomonic pattern.
- A normal ECG does not exclude the diagnosis of HCM.
- Echocardiography provides crucial morphological classification that complements ECG findings.
Abstract:
To evaluate the correlation between electrocardiographic and echocardiographic m-mode (E-TM) and two-dimensional (E-2D) patterns, 116 patients with hypertrophic cardiomyopathy (HCM) were studied by these two methods. Patients were classified into four types, according to Maron et al's E-2D classification of HCM. In addition a subgroup (IIIb) of 15 patients in types III, had typical left ventricular concentric hypertrophy. Twelve per cent of the study patients had a normal ECG, and most often those patients showed types I-II and IIIb. Left ventricular hypertrophy by ECG was most frequent (46%) and was found mostly in type III (P less than 0.02). Abnormal Q waves, suggestive but not diagnostic of HCM, were found in 22 of 116 (18%) patients, and were present in equal proportion in each morphologic type. Isolated ST-T changes were found in the same percentage of patients. Six of 7 patients with giant negative T waves had apical left ventricular hypertrophy, but 4 other patients with apical hypertrophy had no such ECG findings. Mean left atrial dimensions at E-TM, although larger in patients with atrial fibrillation, with statistical significance (P less than 0.001), were not predictive of this arrhythmia. ECG is still useful in the diagnosis of HCM, although there is no abnormal pattern specific for the disease, and even a normal ECG can be found in these patients.