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The left ventriculographic pattern and serial electrocardiographic changes in hypertrophic cardiomyopathy patients
1Second Department of Internal Medicine, Nagasaki University School of Medicine, Japan.
Insights
In hypertrophic cardiomyopathy (HCM), left ventriculogram (LVG) configurations like spade and papillary muscle hypertrophy (PMH) show evolving ECG changes. Giant negative T waves and SV1+RV5 voltage decrease over time in spade and PMH types.
Area of Science:
- Cardiology
- Medical Imaging
- Electrocardiography
Background:
- Hypertrophic cardiomyopathy (HCM) is a complex cardiac condition.
- Left ventriculogram (LVG) configurations offer insights into HCM.
- ECG characteristics like giant negative T (GNT) waves and SV1+RV5 voltage can indicate disease progression.
Purpose of the Study:
- To classify LVG configurations in HCM patients.
- To analyze serial ECG changes in different LVG types.
- To understand the progression of hypertrophy in HCM.
Main Methods:
- Classification of LVG into spade, papillary-muscle hypertrophy (PMH), oval, and banana types in 64 HCM patients.
- Serial ECG monitoring for changes in giant negative T (GNT) waves and SV1+RV5 voltage.
- Longitudinal observation of patients with different LVG configurations.
Main Results:
- Spade, PMH, and oval types were observed for mean periods of 66, 90, and 91 months, respectively.
- GNT waves decreased significantly in spade and PMH types, but not in the oval type.
- SV1+RV5 voltage decreased significantly in the PMH type, with no significant changes in spade or oval types.
Conclusions:
- Apical hypertrophy is established early in spade and PMH types of HCM.
- Hypertrophy may still be progressing in some patients with the oval LVG type.
- Serial ECG changes reflect the dynamic nature of hypertrophy in different LVG configurations.
Abstract:
The configuration of the left ventriculogram (LVG) was classified in 64 patients with hypertrophic cardiomyopathy (HCM) observed in ECG, and characteristics of the configuration and serial changes in SV1+RV5 and giant negative T (GNT) waves were studied. The LVG configuration was classified into the spade (15 patients), papillary-muscle hypertrophy (PMH; n = 23), oval (n = 24) and banana types (n = 2). The spade, PMH and oval types were observed for mean periods of 66, 90 and 91 months, respectively. Serial changes in ECG were as follows: GNT decreased from 16.7 +/- 3.3 to 13.3 +/- 5.1 mm in the spade type and decreased significantly from 16.9 +/- 5.9 to 9.8 +/- 6.9 mm in PMH but showed no changes in the oval type. SV1+RV5 decreased significantly from 69.0 +/- 14.9 to 58.2 +/- 14.7 mm in PMH but showed no significant changes in the spade or oval types. Thus GNT decreased progressively in many patients with the exception of a few with the oval type. From these findings, we consider that apical hypertrophy had been established at the time of the initial LVG and changed over time thereafter in the spade and PMH types but that hypertrophy was still in progress in some patients with the oval type.