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[Left ventriculography and serial ECG changes in hypertrophic cardiomyopathy with special reference to the negative T
Insights
Left ventriculogram configuration in hypertrophic cardiomyopathy (HCM) correlates with serial ECG T wave changes. Spade-shaped configurations are linked to marked apical hypertrophy and deep negative T waves, indicating potential for significant ECG evolution.
Area of Science:
- Cardiology
- Medical Imaging
- Electrocardiography
Background:
- Hypertrophic cardiomyopathy (HCM) is a complex cardiac condition.
- Understanding the relationship between left ventricular morphology and electrocardiogram (ECG) findings is crucial for patient management.
- Asymmetrical septal hypertrophy is a common feature in HCM, influencing ventricular dynamics and electrical activity.
Purpose of the Study:
- To investigate the correlation between left ventriculogram configurations and serial ECG changes in patients with HCM.
- To determine if specific ventricular shapes predict the development or progression of T wave abnormalities.
Main Methods:
- Analyzed left ventriculograms of 16 patients with HCM and asymmetrical septal hypertrophy.
- Classified ventricular configurations (round, round with inferior concavity, spade, spade with inferior concavity) in the right oblique view at end-diastole.
- Divided patients into groups based on serial T wave changes (marked vs. no marked changes) and T wave negativity trends (increasing vs. decreasing).
Main Results:
- Spade-shaped configurations (S, S-i) were associated with marked apical hypertrophy and deep negative T waves (71% in the marked ECG change group).
- Round configurations (R, R-i) showed milder apical hypertrophy, with some developing deep negative T waves during observation (44% in the marked ECG change group).
- Initial T wave negativity depth correlated with apical wall thickness and voltage criteria (SV1 + RV5); increasing T wave negativity correlated with increased SV1 + RV5, while decreasing negativity correlated with decreased SV1 + RV5.
Conclusions:
- HCM with deep negative T waves tends to exhibit significant T wave alterations during serial ECG monitoring and apical hypertrophy on left ventriculography.
- Increasing T wave negativity in HCM is associated with a marked increase in QRS voltage (SV1 + RV5).
- Decreasing T wave negativity in HCM is associated with a decrease in QRS voltage (SV1 + RV5), suggesting a link between these ECG changes and apical wall thickness.
Abstract:
To clarify the correlation between the configuration of the left ventriculogram and serial ECG changes, 16 patients with hypertrophic cardiomyopathy (HCM) associated with asymmetrical septal hypertrophy were examined. In the right oblique view at end-diastole, the configurations were classified by form as round (R, n = 7), round with inferior concavity (R-i, n = 2), spade (S, n = 4) and spade with inferior concavity (S-i, n = 3). These patients were divided into two groups according to serial T wave changes; nine with marked changes (A group) and seven without (B group). Furthermore, group A was separated into two subgroups; seven with increasing negativity or appearance of the negative T wave (A-1 group) and two with decreasing negativity or disappearance of the negative T wave (A-2 group). The results were as follows: Five (71%) of the seven cases with the S and S-i form belonged to the A group. Their apical walls showed marked hypertrophy and their ECGs showed deep negative T waves. The other two cases (29%) belonged to the B group, and did not show marked apical hypertrophy. Four (44%) of the nine cases with the R and R-i form belonged to the A group. They showed mild apical hypertrophy, and initially did not show deep negative T waves. A deep negative T wave appeared in three during observation. The initial depth of the maximum negativity of T wave correlated significantly with apical wall thickness, SV1 + RV5, and the total depth of the negative T wave in precordial leads. During the observation, the A-1 group showed a marked increase of SV1 + RV5. The A-2 group showed a decrease of SV1 + RV5. In conclusion, HCM with deep negative T waves has a tendency to present wide changes in the T wave during serial ECG observation and to show apical hypertrophy on left ventriculography. Cases of increasing negativity of the T wave showed marked increase in voltage of SV1 + RV5. However, cases of decreasing negativity of the T wave showed decreasing SV1 + RV5. These ECG changes, especially the negative T wave changes are reputed to be related to apical wall thickness.