Diagnostic and prognostic electrocardiographic features in patients with hypertrophic cardiomyopathy

Area of Science:

• Cardiology
• Genetics
• Diagnostic Imaging

Background:

• Hypertrophic cardiomyopathy (HCM) is the most common inherited heart muscle disease.
• The 12-lead electrocardiogram (ECG) is a cost-effective and widely available diagnostic tool for HCM.
• ECG can be normal in a small percentage of adult and pediatric patients.

Purpose of the Study:

• To evaluate the diagnostic and prognostic role of the standard 12-lead ECG in hypertrophic cardiomyopathy.
• To identify specific ECG findings indicative of HCM.
• To differentiate sarcomeric HCM from other cardiac conditions using ECG.

Main Methods:

• Analysis of standard 12-lead ECGs from patients with diagnosed HCM.
• Identification and categorization of specific ECG abnormalities associated with HCM.
• Comparison of ECG findings in HCM with other cardiac phenocopies.

Main Results:

• The ECG is abnormal in the majority of HCM patients, though normal in 4-6% of adults and <3% of children.
• Specific findings include pathological Q-waves, deep S-waves, high R-waves, and T-wave abnormalities (depression, negative, or giant negative T-waves in apical HCM).
• Non-specific ST-T changes or isolated inverted T-waves in lateral leads (e.g., aVL) can also indicate HCM.

Conclusions:

• The ECG is a crucial tool for diagnosing HCM and distinguishing it from phenocopies like cardiac amyloidosis or Fabry disease.
• ECG findings can provide prognostic information, identifying high-risk features.
• Even non-specific or subtle ECG changes can be indicative of HCM.