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Late Gadolinium Enhancement and Electrocardiographic Associations in Hypertrophic Cardiomyopathy

Issa Asfour1, Shahid Karim2,3, Sair A Tabraiz2

  • 1East Tennessee State University, Johnson City, Tennessee, USA.

Annals of Noninvasive Electrocardiology : the Official Journal of the International Society for Holter and Noninvasive Electrocardiology, Inc
|June 4, 2025
PubMed

Insights

Late gadolinium enhancement (LGE) in hypertrophic cardiomyopathy (HCM) is linked to T-wave inversion on ECG but not precordial voltage. LGE did not increase atrial fibrillation risk in this adult study.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Electrophysiology

Background:

  • Late gadolinium enhancement (LGE) via cardiovascular magnetic resonance (CMR) identifies myocardial fibrosis in hypertrophic cardiomyopathy (HCM).
  • The relationship between LGE, electrocardiogram (ECG) abnormalities, and atrial fibrillation (AF) risk in adult HCM patients is not fully understood.

Purpose of the Study:

  • To examine the association between LGE presence and extent with ECG characteristics.
  • To assess the link between LGE and the incidence of AF in adults with HCM.

Main Methods:

  • Retrospective cohort study of 144 adult HCM patients.
  • CMR and 12-lead ECG data collected within 30 days.
  • LGE quantified as % LV mass; categorized as absent, <5%, or ≥5%.
  • ECG parameters analyzed, including QRS voltage and repolarization abnormalities.
  • Median follow-up of 6.6 years for incident AF assessment.

Main Results:

  • LGE present in 67% of patients; 22% had ≥5% LGE.
  • No significant difference in precordial voltage across LGE groups.
  • T-wave inversion more frequent in leads I, aVL, and V4 in patients with LGE.
  • Patients with ≥5% LGE showed significantly lower LVEF.
  • LGE presence was not associated with increased AF risk (HR 1.8, 95% CI 0.6-5.3).

Conclusions:

  • In adult HCM, LGE correlates with specific ECG repolarization abnormalities, notably T-wave inversion in lateral leads.
  • LGE does not significantly impact precordial voltage in adult HCM patients.
  • Findings contrast with pediatric HCM, highlighting age-specific associations.
Abstract

Keywords:
T‐wave inversionatrial fibrillationcardiac MRIelectrocardiogramhypertrophic cardiomyopathylate gadolinium enhancement

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