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[Correlation between left ventricular wall thickness and the depth of negative T waves in apical hypertrophic
Insights
Electrocardiographic findings in apical hypertrophic cardiomyopathy, including high QRS voltage and giant negative T waves, correlate with apical segment thickness. This relationship is crucial for accurate diagnosis.
Area of Science:
- Cardiology
- Medical Imaging
- Electrophysiology
Context:
- Apical hypertrophic cardiomyopathy (AHC) presents unique electrocardiographic (ECG) features.
- High QRS voltage and giant negative T waves (>10 mm) in left precordial leads are characteristic of AHC.
- Understanding the correlation between left ventricular (LV) wall thickness and ECG findings is clinically significant.
Purpose:
- To investigate the relationship between left ventricular (LV) wall thickness and the depth of negative T waves in patients with apical hypertrophic cardiomyopathy.
- To determine if LV wall thickness distribution or absolute apical thickness is more closely associated with negative T wave depth.
Summary:
- Left ventriculogram (LVG) analysis revealed a significant correlation between negative T wave depth and the absolute thickness of the LV apical segment in AHC.
- This finding supports the observation of giant negative T waves in cases with diffuse LV hypertrophy, not solely spade-like configurations.
- Echocardiographic analysis showed no relation between negative T wave depth and LV hypertrophy distribution, likely due to measurement limitations of the apical segment.
Impact:
- The study highlights the importance of absolute apical segment thickness in ECG manifestations of AHC.
- Accurate diagnosis of AHC requires the presence of both high QRS voltage and giant negative T waves.
- Improved understanding may refine diagnostic criteria and imaging protocols for AHC.
Abstract:
Electrocardiographic features of apical hypertrophic cardiomyopathy are high QRS voltage and giant negative T waves greater than 10 mm in left precordial leads. We analyzed thirty patients with apical hypertrophic cardiomyopathy to clarify the correlation between left ventricular (LV) wall thickness and the depth of negative T waves. LV anterior wall thickness was measured by the left ventriculogram (LVG) in the RAO projection. LV posterior wall and septal thickness were measured by echocardiograms recorded from the left sternal border. THA and THM were defined as apical thickness and mid ventricular wall thickness, respectively. The results were as follows: LVG disclosed that the depth of negative T waves in apical hypertrophic cardiomyopathy was significantly related to the absolute thickness of apical segment itself rather than the difference in the distribution of thickness from the basal to apical segment of the left ventricle. This results support the clinical observation that giant negative T waves in some cases are associated with diffuse hypertrophy of the LV without a spade like configuration in LVG. Results of the echocardiographic analysis, however, revealed that the depth of negative T waves had no relation to the distribution of left ventricular hypertrophy. This is partly because of unsatisfied and difficult recordings and measurements of the true LV apical segment by echocardiography. The presence of both high QRS voltage and giant negative T waves is indispensable for the diagnosis of apical hypertrophy.