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Electrocardiographic findings in patients with obstructive and nonobstructive hypertrophic cardiomyopathy
Insights
Electrocardiograms in hypertrophic cardiomyopathy are rarely normal, often showing abnormalities like hypertrophy. Unusual ECG findings may indicate hypertrophic cardiomyopathy, even with normal physical exams.
Area of Science:
- Cardiology
- Medical Diagnostics
Background:
- Hypertrophic cardiomyopathy (HCM) is a complex cardiac condition.
- Diagnostic challenges exist, particularly in asymptomatic or non-obstructive cases.
Purpose of the Study:
- To investigate the prevalence and spectrum of electrocardiographic (ECG) abnormalities in patients with hypertrophic cardiomyopathy.
- To determine the correlation between ECG findings and echocardiographic/hemodynamic parameters.
Main Methods:
- Standard 12-lead electrocardiography was performed on 134 patients with hypertrophic cardiomyopathy.
- Echocardiography and hemodynamic measurements (pulmonary capillary wedge pressure, left ventricular end-diastolic pressure) were analyzed.
Main Results:
- Normal ECGs were uncommon (<7% in most subgroups, 27% in asymptomatic/non-obstructive).
- Repolarization abnormalities (81%) and left ventricular hypertrophy (62%) were most prevalent.
- ECG evidence of left ventricular hypertrophy/left atrial abnormality correlated with increased septal thickness, left atrial dimension, and elevated filling pressures.
Conclusions:
- ECG abnormalities are highly prevalent and diverse in hypertrophic cardiomyopathy.
- Unexplained ECG abnormalities warrant suspicion for HCM, irrespective of physical examination findings.
Abstract:
One hundred and thiry-four patients with hypertrophic cardiomyopathy were evaluated by standard 12-lead electrocardiography. Normal electrocardiograms were extremely uncommon, occurring in less than 7% of each subgroup of patients (i.e., those with or without either symptoms or obstruction to left ventricular outflow), with the exception of those who were both asymptomatic and had no left ventricular outflow obstruction. Even in this subgroup, however, normal electrocardiograms occurred in only 27% of patients. Repolarization abnormalities and left ventricular hypertrophy were the most common abnormalities, occurring in 81% and 62%, respectively, of the total population. A broad spectrum of other electrocardiographic abnormalities was found, but none was unique to hypertrophic cardiomyopathy. Patients with vs those without electrocardiographic left ventricular hypertrophy or left atrial abnormality had significantly (P less than 0.005) greater mean ventricular septal thickness (22 +/- 0.6 vs 19 +/- 0.6 mm) and left atrial dimension (48 +/- 1 vs 40 +/- 1 mm) measured by echocardiography, and signficantly (P less than 0.01) higher mean pulmonary capillary wedge pressure (16 +/- 1 vs 10 +/- 1 mm Hg) and left ventricular end-diastolic pressure (20 +/- 1 vs 15 +/- 1 mm Hg). The high prevalence and diverse nature of electrocardiographic abnormalities suggest that any patient with an unusual and unexplained electrocardiogram should be suspected of having hypertrophic cardiomyopathy even if the physical examination is normal, as is often the case in patients without obstruction.