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[Serial changes in left ventricular configuration and function in hypertrophic cardiomyopathy]
1Second Department of Internal Medicine, School of Medicine, Kanazawa University.
Insights
Serial electrocardiogram (ECG) changes correlate with left ventricular remodeling in hypertrophic cardiomyopathy (HCM). ECG negativity progression indicates worsening diastolic dysfunction and wall thickening, while resolution suggests improvement.
Area of Science:
- Cardiology
- Medical Imaging
- Electrophysiology
Background:
- Hypertrophic cardiomyopathy (HCM) is a complex cardiac condition requiring long-term monitoring.
- Serial assessment of left ventricular (LV) structure and function is crucial for understanding HCM progression.
- Electrocardiogram (ECG) changes, particularly T-wave abnormalities, may reflect underlying myocardial remodeling.
Observation:
- Fifteen patients with HCM underwent serial left ventriculography and bi-ventriculography.
- ECG changes, including T-wave negativity, were correlated with LV configuration, wall thickness, and function.
- Patients were categorized into groups based on ECG changes: progressive T-wave negativity (A-1), resolving T-wave negativity (A-2), and insignificant changes (B).
Findings:
- Group A-1 showed increased apical and anterior wall thickness, progression of diastolic dysfunction, and a shift towards a "spade" LV configuration.
- Group A-2 exhibited decreased wall thickness, significant decline in LV function, and a shift towards a "round" LV configuration; two cases progressed to dilated cardiomyopathy.
- Group B demonstrated stable LV parameters and function, correlating with minimal ECG changes.
Implications:
- Serial ECG findings can serve as non-invasive indicators of dynamic left ventricular remodeling in hypertrophic cardiomyopathy.
- Understanding these correlations aids in predicting disease course and potential progression to dilated cardiomyopathy.
- This study highlights the importance of integrating ECG monitoring with detailed cardiac imaging for comprehensive HCM management.
Abstract:
Fifteen patients, 12 males and three females, with hypertrophic cardiomyopathy (HCM) including three of obstructive type (HOCM) were investigated to observe the long-term course of HCM. Left ventriculography and bi-ventriculography were performed twice serially in all cases. We studied the correlations between the serial ECG changes, especially the negative T wave, and the left ventricular configuration, wall thickness, and left ventricular function. Serial ECG changes included: 1) negativity of the T wave which developed or increased concomitantly with increased voltages of SV1 + RV5 (A-1 group: five cases), 2) the negativity decreased or resolved with decreased voltages of SV1 + RV5 (A-2 group: four cases), and 3) insignificant changes of both T waves and SV1 + RV5 (B group: six cases). In the right oblique views at end-diastole, the configuration of the left ventricle was classified in three forms; (1) spade form (S), (2) round form (R), and (3) intermediate form (SR). The results were as follows: 1. The A-1 group showed increased thickness of the apical and anterior walls, but the thickness of the posterior wall and interventricular septal wall did not change serially. In three cases, the thickness of the interventricular septum showed mild hypertrophy at the initial and final observations. The configuration changed from the R or SR form to the S form. Diastolic dysfunction (peak dV/dt/V, peak dV/dt/EDV) was progressive, but end-diastolic volume and ejection fraction did not change. 2. The A-2 group showed the significantly decreased thickness of the apical and anterior walls. The thicknesses of the posterior wall and interventricular septal wall tended to decrease in all cases. In three cases (75%), the interventricular septal wall was markedly hypertrophied on the initial observation. The configuration changed from the S or SR form to the R form. Left ventricular diastolic function and ejection fraction decreased significantly and end-diastolic volume increased. Two cases showed clinical pictures of dilated cardiomyopathy at the final observation. 3. In the B group, there were no marked changes in wall thickness, left ventricular configuration, or systolic and diastolic functions. In conclusion, serial changes in left ventricular configuration, wall thickness, especially of the anterior and apical walls, and left ventricular function were all compatible with the serial changes of the ECG in hypertrophic cardiomyopathy.(ABSTRACT TRUNCATED AT 400 WORDS)