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Relationship between electrocardiographic features and distribution of hypertrophy in patients with hypertrophic
T Sato1, K Nakamura, H Yamanari
1Department of Cardiovascular Medicine, Okayama University, Okayama Pref., Japan.
Insights
Electrocardiographic findings in hypertrophic cardiomyopathy (HCM) correlate with hypertrophy distribution. Abnormal Q waves indicate regional hypertrophy, while T-wave patterns reveal differences in basal versus apical hypertrophy localization.
Area of Science:
- Cardiology
- Medical Imaging
- Electrophysiology
Background:
- Hypertrophic cardiomyopathy (HCM) is a genetic heart muscle disease.
- The distribution of myocardial hypertrophy in HCM can vary.
- Electrocardiographic (ECG) findings are commonly observed in HCM patients.
Purpose of the Study:
- To investigate the association between the spatial distribution of hypertrophy in HCM and specific ECG findings.
- To determine if different patterns of hypertrophy correlate with distinct ECG abnormalities.
Main Methods:
- 54 patients diagnosed with HCM were included in the study.
- Magnetic resonance imaging (MRI) was used to assess the distribution of hypertrophy.
- Patients were categorized into four groups based on hypertrophic patterns: apical, apical and basal, basal with asymmetric septal hypertrophy (ASH), and basal without ASH.
Main Results:
- Abnormal Q waves in inferior leads (II, III, aVF) were more prevalent in patients with basal hypertrophy, particularly those with ASH.
- Abnormal Q waves in lateral leads (I, aVL) were observed more frequently in patients with both apical and basal hypertrophy.
- The amplitude of negative T waves was largest in patients with isolated apical hypertrophy, while positive T waves were most prominent in those with basal hypertrophy without ASH.
Conclusions:
- The presence of abnormal Q waves in ECGs of HCM patients is indicative of regional hypertrophy.
- T-wave configurations on ECGs can differentiate between hypertrophy localized to the basal versus apical segments of the heart.
- ECG analysis, combined with imaging, can provide insights into the specific patterns of hypertrophy in HCM.
Abstract:
To evaluate the relationship between the distribution of hypertrophy and the electrocardiographic findings in patients with hypertrophic cardiomyopathy (HCM), 54 HCM patients were studied using magnetic resonance imaging. The patients were divided into 4 groups according to hypertrophic patterns: (i) hypertrophy only at the apex (group I, n=12); (ii) hypertrophy in both the apex and base (group II, n=20); (iii) hypertrophy only at the base with asymmetric septal hypertrophy (ASH) (group IIIa, n=17); and (iv) hypertrophy only at the base without ASH (group IIIb, n=5). Abnormal Q waves in leads II, III and aVF were found in 1/12, 3/20, 10/17 and 0/5, respectively, and in leads I and aVL they were found in 1/12, 8/20, 4/17 and 1/5, respectively. The largest negative T waves (mm) were found in group I (group I vs group II vs group IIIa vs group IIIb: 15.2+/-5.3, 8.2+/-6.1, 1.6+/-2.0, 0.8+/-1.3, respectively). The largest positive T waves (mm) were identified in group IIIb (3.8+/-3.0, 6.8+/-3.2, 5.8+/-3.6, 9.3+/-2.1, respectively). The presence of abnormal Q waves reflected regional hypertrophy in HCM patients but the configuration of T waves represented the difference in the localization of hypertrophy between the basal and apical segments.