Extent of Myocardial Hyperenhancement on Late Gadolinium-Enhanced Cardiovascular Magnetic Resonance Correlates with Q Waves in Hypertrophic Cardiomyopathy

Papavassiliu, Theano; Flüchter, Stephan; Haghi, Dariusch; Süselbeck, Tim; Wolpert, Christian; Dinter, Dietmar; Kühl, Harald P.; Borggrefe, Martin

doi:10.1080/10976640600945465

Cited by 19 publications

(12 citation statements)

References 35 publications

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“…Previous studies attempting to clarify the anatomic basis of Q waves in HC through CMR imaging have yielded conflicting explanations. 30,31 Similarly, we were unable to identify instructive imaging or clinical correlates of these ECG changes in overt HC or G+/LVH− subjects, including LGE as a reflection of gross myocardial scar.…”

Section: Discussionmentioning

confidence: 88%

Electrocardiographic Features of Sarcomere Mutation Carriers With and Without Clinically Overt Hypertrophic Cardiomyopathy

Lakdawala

Thune

Maron

et al. 2011

The American Journal of Cardiology

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In hypertrophic cardiomyopathy (HC), ECG changes have been postulated to be an early marker of disease, detectable in sarcomere mutation carriers when LV wall thickness is still normal However, the ECG features of mutation carriers have not been fully characterized. Therefore, we systematically analyzed ECG’s in a genotyped HC population to: 1. Characterize ECG findings in mutation carriers (G+) with and without echocardiographic left ventricular hypertrophy (LVH), and 2. Evaluate the accuracy of the ECG to differentiate at- risk mutation carriers from genetically unaffected relatives during family screening. ECGs and echocardiograms were analyzed in 213 genotyped subjects (76 G+/LVH−, 57 G+/LVH+ overt HC, 80 genetically unaffected controls). Cardiac magnetic resonance imaging (CMR) was available on a subset. Q waves and repolarization abnormalities (QST) were highly specific (98%) markers for LVH− mutation carriers, present in 25% of G+/LVH− subjects and 3% of controls (p<0.001). QST ECG abnormalities remained independently predictive of carrying a sarcomere mutation after adjusting for age and impaired relaxation, another distinguishing feature of G+/LVH− subjects (OR 8.4, p=0.007). Myocardial scar or perfusion abnormalities were not detected on CMR in any G+/LVH− subjects, irrespective of ECG features. In overt HC, 75% had Q waves and/or repolarization changes but <25% demonstrated common isolated voltage criteria for LVH. In conclusion, Q waves and repolarization abnormalities are the most discriminating ECG features of sarcomere mutation carriers with and without LVH. However, due to the limited sensitivity of ECG and echocardiographic screening, genetic testing is required to definitively identify at-risk family members.

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Section: Discussionmentioning

confidence: 88%

Electrocardiographic Features of Sarcomere Mutation Carriers With and Without Clinically Overt Hypertrophic Cardiomyopathy

Lakdawala

Thune

Maron

et al. 2011

The American Journal of Cardiology

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“… 15 21 An abnormal Q wave was determined as described by Konno et al 22 by a Q wave >0.3 mV in depth and/or >0.04 s in duration in at least two leads except aVR. 19 22 …”

Section: Methodsmentioning

confidence: 99%

“… 16 17 In the era of CMR, some studies suggested an association between abnormal Q wave and LGE. 14 18 19 However, few studies compared ECG findings to the mere presence of LGE.…”

Section: Introductionmentioning

confidence: 99%

ECG characteristics according to the presence of late gadolinium enhancement on cardiac MRI in hypertrophic cardiomyopathy

et al. 2014

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BackgroundLate gadolinium enhancement (LGE) on cardiac MRI (CMR) has been described as an independent predictive factor of cardiovascular events among patients with hypertrophic cardiomyopathy (HCM). LGE and Q waves are considered as myocardial scar markers but their relation in the context of HCM is poorly established and has to be more supported. The objective of the study was to compare ECG findings in the presence or absence of LGE.Methods42 patients with HCM confirmed by CMR were included in the study. ECG abnormalities including abnormal Q waves and five ECG scores of left ventricular hypertrophy were assessed and compared according to LGE presence and its extension. Some CMR features, such as septal to posterior wall thickness ratio, were also studied according to the presence of LGE and the presence of abnormal Q waves.ResultsAbnormal Q waves were more prevalent in the LGE (+) group (60% vs 12%; p=0.002), but there was no correlation between location of Q waves on ECG and territory of LGE on CMR. Among patients with LGE, quantitative analysis of LGE was not different in the presence or absence of Q waves. In contrast to the LGE mass, septal to posterior wall thickness was higher in patients with abnormal Q waves (2.3±0.7 vs 1.6±0.5; p=0.012).ConclusionsAlthough abnormal Q waves were more prevalent in the presence of LGE, no correlation was found with the LGE location and extent. These data suggest that abnormal electrical activation of the hypertrophied ventricular septum represented by a high septal to posterior wall thickness ratio seems to be an important mechanism of abnormal Q waves in HCM.

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“…Each segment was visually scored for the total extent of LGE as previously described [19]. The 17 segments were grouped into four cardiac regions: To determine the LGE extent in the septal and lateral regions, the scores of these segments were summed.…”

Section: Lge Quantificationmentioning

confidence: 99%

Mitral annular plane systolic excursion is an easy tool for fibrosis detection by late gadolinium enhancement cardiovascular magnetic resonance imaging in patients with hypertrophic cardiomyopathy

Doesch

Sperb

Sudarski³

et al. 2015

Archives of Cardiovascular Diseases

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MAPSE measurement using CMR is feasible, reproducible and comparable to echocardiography in healthy controls and patients with HCM. The asymmetric and mainly septal distribution of myocardial hypertrophy and fibrosis detected by LGE in patients with HCM was reflected by significantly reduced septal versus lateral MAPSE. Therefore, reduced MAPSE seems to be an easily determinable marker of fibrosis accumulation leading to left ventricular mechanical dysfunction and also seems to have a prognostic implication.

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Extent of Myocardial Hyperenhancement on Late Gadolinium-Enhanced Cardiovascular Magnetic Resonance Correlates with Q Waves in Hypertrophic Cardiomyopathy

Cited by 19 publications

References 35 publications

Electrocardiographic Features of Sarcomere Mutation Carriers With and Without Clinically Overt Hypertrophic Cardiomyopathy

Electrocardiographic Features of Sarcomere Mutation Carriers With and Without Clinically Overt Hypertrophic Cardiomyopathy

ECG characteristics according to the presence of late gadolinium enhancement on cardiac MRI in hypertrophic cardiomyopathy

Mitral annular plane systolic excursion is an easy tool for fibrosis detection by late gadolinium enhancement cardiovascular magnetic resonance imaging in patients with hypertrophic cardiomyopathy

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