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[Electrocardiographic differences between apical hypertrophic cardiomyopathy and apical non-ST segment myocardial
Iván Chillik1, Andreina Gil Ramírez1, Santiago Ordóñez1
1Departamento de Cardiología Clínica, Instituto Cardiovascular de Buenos Aires, Argentina.
Insights
Apical hypertrophic cardiomyopathy (AHCM) shows distinct electrocardiographic patterns compared to apical non-ST segment elevation myocardial infarction (NSTEMI). Differentiating these conditions prevents unnecessary cardiac studies and treatments.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Diagnostics
Background:
- Apical hypertrophic cardiomyopathy (AHCM) presents with ventricular repolarization alterations.
- These electrocardiographic changes can mimic anterior infarction, leading to potentially unnecessary investigations and treatments.
Purpose of the Study:
- To describe and compare electrocardiographic differences between AHCM and apical NSTEMI with T-wave changes.
- To identify key ECG markers for distinguishing AHCM from apical NSTEMI.
Main Methods:
- Observational, retrospective study comparing 19 patients with AHCM and 19 with apical NSTEMI.
- Analysis of electrocardiographic (ECG) parameters, including T-wave voltage, R-wave amplitude, and R+T wave summation.
Main Results:
- AHCM patients exhibited significantly higher T-wave voltage, peak voltage, R-waves, and R+T summation compared to NSTEMI patients.
- Greater T-wave asymmetry (TiTp/TpTf ratio > 1) was observed in AHCM.
- An R+T cut-off value of 26.5 mV demonstrated 68% sensitivity and 100% specificity for diagnosing AHCM.
Conclusions:
- Significant electrocardiographic differences exist between AHCM and apical NSTEMI.
- ECG analysis, particularly R+T wave summation, can aid in differentiating these conditions, optimizing patient management.
Abstract:
Apocal hypertrophic cardiomyopathy (AHCM) is a phenotypic variant within hypertrophic cardiomyopathies, in which ventricular repolarization alterations are present. These electrocardiographic disturbances can mimic an anterior infarction which triggers a series of studies and treatments that may be unnecessary. The aim of this study was to describe and compare electrocardiographic differences in a series of patients with AHCM and apical non-ST segment elevation myocardial infarction in patients (NSTEMI) with T-wave changes. We conducted an observational and retrospective study, including patients with diagnosed AHCM (N = 19) and apical NSTEMI (N = 19) with negative T waves in V1 and V6 lead of the EKG. Those with AHCM presented higher T-wave voltage (7 mV vs. 5 mV, p = 0.001) and peak voltage (29 mV vs. 17 mV, p = 0.003), higher R-waves (25 mV vs. 10 mV, p = 0.0001), and a maximum voltage of R and T sum (R + T) significantly higher (33 vs. 14, p = 0.00001). They also showed a greater T-wave asymmetry, with a TiTp / TpTf ratio > 1. At a cut-off value of 26.5 mV for the R + T variable, 68% sensitivity and 100% specificity were obtained to diagnose AHCM. This study shows the existence of major differences in electrocardiographic presentation of AHCM and apical NSTEMI.
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