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Relationship between distribution of hypertrophy and electrocardiographic changes in hypertrophic cardiomyopathy
1Second Department of Internal Medicine, Tokyo University Hospital, Japan.
Insights
The distribution of left ventricular hypertrophy in hypertrophic cardiomyopathy influences electrocardiogram (ECG) T-wave patterns. Apical hypertrophy is associated with negative T waves, while basal hypertrophy correlates with positive T waves.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- Hypertrophic cardiomyopathy (HCM) is a genetic heart disease characterized by left ventricular hypertrophy.
- Electrocardiographic (ECG) abnormalities are common in HCM but their relationship with hypertrophy distribution is not fully understood.
Purpose of the Study:
- To investigate the correlation between the specific distribution of left ventricular hypertrophy and ECG findings in patients with HCM.
- To determine if different patterns of hypertrophy predict specific T-wave polarities on the ECG.
Main Methods:
- Correlating magnetic resonance imaging (MRI) findings of hypertrophy distribution with ECG data.
- Analyzing T-wave characteristics (negative, giant negative, tall positive) in precordial leads across three patient groups based on hypertrophy location: apical (Group I), apical and basal (Group II), and basal (Group III).
Main Results:
- Patients with apical hypertrophy (Group I) showed significantly more precordial leads with negative T waves compared to Groups II and III (p < 0.01).
- Giant negative T waves were prevalent in apical hypertrophy (52%) and apical/basal hypertrophy (33%), but absent in basal hypertrophy.
- Tall positive T waves were observed in basal hypertrophy (45%) and apical/basal hypertrophy (13%), but not in purely apical hypertrophy.
Conclusions:
- The topographical distribution of hypertrophy in hypertrophic cardiomyopathy is a key determinant of T-wave polarity observed in precordial ECG leads.
- Specific patterns of hypertrophy, such as apical versus basal, are associated with distinct ECG manifestations, aiding in diagnosis and risk stratification.
Abstract:
To assess the relationship between the distribution of hypertrophy and electrocardiographic changes in patients with hypertrophic cardiomyopathy, magnetic resonance imaging and ECG findings were correlated in 25 patients with apical hypertrophy (group I), 15 patients with both apical and basal hypertrophy (group II), and 11 patients with hypertrophy localized to the basal left ventricle (group III). The number of precordial leads with negative T waves (-0.5 mV or more) was greater in group I than in groups II and III (I = 3.0 +/- 1.5, II = 1.7 +/- 1.5, III = 0.3 +/- 0.6; p < 0.01). Giant negative T waves (-1.0 mV or more) in precordial leads were found in 13 patients (52%) in group I and five patients (33%) in group II but were not found in group III. In contrast, tall positive T waves (> or = 1.0 mV) in precordial leads were found in two patients (13%) in group II and five (45%) in group III but were not found in group I. These results suggest that the distribution of hypertrophy in patients with hypertrophic cardiomyopathy produces a particular T wave polarity in precordial leads.