Electrocardiographic evolution in patients with hypertrophic cardiomyopathy who develop a left ventricular apical aneurysm

Pennacchini, Ermelinda; Musumeci, Beatrice; Conte, Maria Rosa; Stöllberger, Claudia; Formisano, Francesco; Bongioanni, Sergio; Francia, Pietro; Volpe, Massimo; Autore, Camillo

doi:10.1016/j.jelectrocard.2015.06.004

Cited by 11 publications

(10 citation statements)

References 28 publications

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“…The negative prognostic role of prolonged QRS duration is somewhat expected and, indeed, has been reported by Bongioanni et al 16 as regard to HC-related death. 5 An association with apical aneurism development has also been reported by other investigators.…”

Section: Discussionsupporting

confidence: 54%

Usefulness of Electrocardiographic Patterns at Presentation to Predict Long-term Risk of Cardiac Death in Patients With Hypertrophic Cardiomyopathy

Biagini

Pazzi

Olivotto

et al. 2016

The American Journal of Cardiology

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The objective of this study was to investigate the prognostic significance of 12-lead electrocardiogram (ECG) patterns in a large multicenter cohort of patients with hypertrophic cardiomyopathy; 1,004 consecutive patients with hypertrophic cardiomyopathy and a recorded standard ECG (64% men, mean age 50 ± 16 years) were evaluated at 4 Italian centers. The study end points were sudden cardiac death (SCD) or surrogates, including appropriate implanted cardiac defibrillator discharge and resuscitated cardiac arrest and major cardiovascular events (including SCD or surrogates and death due to heart failure, cardioembolic stroke, or heart transplantation). Prevalence of baseline electrocardiographic characteristics was: normal ECG 4%, ST-segment depression 56%, pseudonecrosis waves 33%, "pseudo-ST-segment elevation myocardial infarction (STEMI)" pattern 17%, QRS duration ≥120 ms 17%, giant inverted T waves 6%, and low QRS voltages 3%. During a mean follow-up of 7.4 ± 6.8 years, 77 patients experienced SCD or surrogates and 154 patients experienced major cardiovascular events. Independent predictors of SCD or surrogates were unexplained syncope (hazard ratio [HR] 2.5, 95% confidence interval [CI] 1.4 to 4.5, p = 0.003), left ventricular ejection fraction <50% (HR 3.5, 95% CI 1.9 to 6.7, p = 0.0001), nonsustained ventricular tachycardia (HR 1.7, 95% CI 1.1 to 2.6, p = 0.027), pseudo-STEMI pattern (HR 2.3, 95% CI 1.4 to 3.8, p = 0.001), QRS duration ≥120 ms (HR 1.8, 95% CI 1.1 to 3.0, p = 0.033), and low QRS voltages (HR 2.3, 95% CI 1.01 to 5.1, p = 0.048). Independent predictors of major cardiovascular events were age (HR 1.02, 95% CI 1.01 to 1.03, p = 0.0001), LV ejection fraction <50% (HR 3.73, 95% CI 2.39 to 5.83, p = 0.0001), pseudo-STEMI pattern (HR 1.66, 95% CI 1.13 to 2.45, p = 0.010), QRS duration ≥120 ms (HR 1.69, 95% CI 1.16 to 2.47, p = 0.007), and prolonged QTc interval (HR 1.68, 95% CI 1.21 to 2.34, p = 0.002). In conclusion, a detailed qualitative and quantitative electrocardiographic analyses provide independent predictors of prognosis that could be integrated with the available score systems to improve the power of the current model.

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Section: Discussionsupporting

confidence: 54%

Usefulness of Electrocardiographic Patterns at Presentation to Predict Long-term Risk of Cardiac Death in Patients With Hypertrophic Cardiomyopathy

Biagini

Pazzi

Olivotto

et al. 2016

The American Journal of Cardiology

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“…HCM patients with apical aneurysms represent a unique subgroup that typically exhibits normal coronary arteries that may eventually lead to sudden death, thrombosis, heart failure, arrhythmia, and electrocardiographic abnormalities. [7,9,11] The incidence of HCM with LV apical aneurysms is reported to be approximately 1% to 4.8% among all HCM patients. [4,9,12] Rowin retrospectively analyzed 1940 consecutive HCM patients at 2 centres, 93 of whom (4.8%) were shown to have LV apical aneurysms; the mean age of that cohort was 56 ± 13 years, and 69% was man.…”

Section: Discussionmentioning

confidence: 99%

“…Echocardiography is the most important modality for the diagnosis of HCM, but it is limited in the assessment of apical aneurysms and proved unreliable in detecting small ventricular aneurysms. [7] Pennacchini's study examined serial ECGs of patients with HCM who gradually developed apical remodelling during a 9-year electrocardiographic follow-up. [7] Various electrocardiographic patterns have been suggested as characteristic or at least suggestive of ventricular aneurysms.…”

Section: Discussionmentioning

confidence: 99%

“…[6] The potential role of electrocardiograms (ECGs) in the detection of apical aneurysms has been defined in HCM patients who exhibit distinctive ECG changes. [7] Other imaging tests, such as magnetic resonance imaging (MRI) and left ventriculography, are also used to diagnose or confirm clinical suspicion of HCM. MRI can assess morphological patterns, cardiac functional parameters, myocardial perfusion, and myocardial scarring in a single examination with no limitations on the view and high spatial and high contrast resolutions.…”

Section: Introductionmentioning

confidence: 99%

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A case report of apical aneurysms and myocardial perfusion deficit with myocardial necrosis due to hypertrophic cardiomyopathy

Gao

Yang²,

Zhang³

et al. 2018

Medicine

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“…We excluded ECGs with paced QRS complexes. Eligible ECGs were analyzed for the presence of symmetric precordial T-wave inversion, signs of early repolarization, and ECG criteria suggesting left ventricular apical aneurysm (convex ST elevation of ≥ 1 mm in ≥ 2 contiguous leads through V1-V4 associated with loss of giant T-wave negativity) as published before (29)(30)(31)(32). Early repolarization pattern was defined according to published recommendations requiring a J-point elevation of ≥ 1 mm in ≥ 2 contiguous inferior and/or lateral leads while excluding leads V1-V3 (33).…”

Section: Ecg Analysismentioning

confidence: 99%

Ventricular Arrhythmia in Septal and Apical Hypertrophic Cardiomyopathy: The French-Canadian Experience

Steinberg

Nadeau-Routhier

André

et al. 2020

Front. Cardiovasc. Med.

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Background: Apical hypertrophic cardiomyopathy (aHCM) is thought to have a more benign clinical course compared to septal HCM (sHCM), but most data have been derived from Asian cohorts. Comparative data on clinical outcome in Caucasian aHCM cohorts are scarce, and the results are conflicting. The aim of this study was to estimate the prevalence and outcome of aHCM in French-Canadians of Caucasian descent. Methods and results: We conducted a retrospective, single-center cohort study. The primary endpoint was a composite of documented sustained ventricular arrhythmia (VA), appropriate ICD therapy, arrhythmogenic syncope, cardiac arrest, or all-cause mortality. A total of 301 HCM patients (65% males) were enrolled including 80/301 (27%) with aHCM and 221/301 (73%) with sHCM. Maximal wall thickness was similar in both groups. Left ventricular apical aneurysm was significantly more common in aHCM (10 vs. 0.5%; p < 0.001). The proportion of patients with myocardial fibrosis ≥ 15% of the left ventricular mass was similar between aHCM and sHCM (21 vs. 24%; p = 0.68). Secondary prevention ICDs were more often implanted in aHCM patients (16 vs. 7%; p = 0.02). The primary endpoint occurred in 26% of aHCM and 10.4% of sHCM patients (p = 0.001) and was driven by an increased incidence of sustained VA (10 vs. 2.3%; p = 0.01). Multivariate analysis identified apical aneurysm and a phenotype of aHCM as independent predictors of the primary endpoint and the occurrence of sustained ventricular tachycardia. Unexplained syncope and a family history of sudden cardiac death were additional predictors for sustained VA. Apical HCM was associated with an increased risk of ventricular arrhythmia even when excluding patients with apical aneurysm. Conclusions: The phenotype of apical HCM is much more common in French-Canadians (27%) of Caucasian descent compared to other Caucasian HCM populations. Apical HCM in French-Canadians is associated with an increased risk for ventricular arrhythmia.

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Electrocardiographic evolution in patients with hypertrophic cardiomyopathy who develop a left ventricular apical aneurysm

Cited by 11 publications

References 28 publications

Usefulness of Electrocardiographic Patterns at Presentation to Predict Long-term Risk of Cardiac Death in Patients With Hypertrophic Cardiomyopathy

Usefulness of Electrocardiographic Patterns at Presentation to Predict Long-term Risk of Cardiac Death in Patients With Hypertrophic Cardiomyopathy

A case report of apical aneurysms and myocardial perfusion deficit with myocardial necrosis due to hypertrophic cardiomyopathy

Ventricular Arrhythmia in Septal and Apical Hypertrophic Cardiomyopathy: The French-Canadian Experience

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