Progression of electrocardiographic changes in a patient with apical hypertrophic cardiomyopathy

Harari, Rafael; Smietana, Jeffrey; Madias, John E.

doi:10.1016/j.jelectrocard.2019.09.025

Cited by 5 publications

(4 citation statements)

References 4 publications

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“…These voltage criteria of ApHCM may be related to both LV hypertrophy or to differences in localized wall thickness leading to disparities in the duration of repolarization. ApHCM is characterized by circular LV hypertrophy, while in NSTEACS, LV hypertrophy presented at the opposite side of the myocardium because of remodeling, thus it is not a circular hypertrophy [26] . In ApHCM, the mechanism for enormous R waves, dramatically in V3-V4 leads, is due to the apical distribution of hypertrophy opposite to the non-muscular elements of the fibrous cardiac skeleton of the mitral valve and annular plane.…”

Section: Discussionmentioning

confidence: 99%

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Usefulness of ECG to differentiate apical hypertrophic cardiomyopathy from non-ST elevation acute coronary syndrome

Tao

Bako

et al. 2020

Preprint

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Objective: Apical hypertrophic cardiomyopathy (ApHCM) is a phenotypic variant of nonobstructive HCM. ApHCM is characterized by left ventricular hypertrophy involve the distal apex. The electrocardiographic character of ApHCM can mimic non-ST elevation acute coronary syndrome (NSTEACS) which triggers a series of studies and treatments that may be unnecessary. This study aimed to clarify the ECG differences between the two diseases.Methods: Initial electrocardiogram (ECG) recordings of 41 patients with ApHCM and 72 patients with NSTEACS were analyzed retrospectively. We analyzed the voltage of negative T (neg T) wave, R wave and the change of ST-segment in the 12-lead ECGs as well as the number of leads with neg T waves.Results: Across the 12-lead ECGs, the magnitude of R wave significantly differed between ApHCM and NSTEACS in 10 leads excluding leads aVR and V1. ApHCM was associated with a greater maximal amplitude of R wave in lead V5 (3.13±1.08 vs. 1.38±0.73, P=0.000). The magnitude of T wave significantly differed between ApHCM and NSTEACS in 10 leads excluding leads II and V1. ApHCM was associated with a greater maximal amplitude of neg T wave in lead V4 (0.85±0.69 vs. 0.35±0.23, P=0.000). The frequency of giant neg T (1mv or more) wave was higher in ApHCM (36.5% vs. 0%, P=0.000). The magnitude of ST-segment deviation significantly differed between ApHCM and NSTEACS in 10 leads excluding leads aVF and V2. ApHCM was associated with a greater maximal amplitude of ST-segment depression in lead V5 (0.19±0.07 vs. 0.03±0.06, P=0.000). The number of leads with neg T waves also differed between ApHCM and NSTEACS (6.75±1.42 vs. 6.08±1.51, P=0.046). The sum of R wave in lead V5, neg T wave in lead V6 and ST-segment depression in lead V4>2.585 mV identified ApHCM with 90.2% sensibility and 87.5% specificity, representing the highest diagnostic accuracy.Conclusions: Compared with NSTEACS patients, ApHCM patients presented higher R waves and neg T wave voltage as well as a greater ST-segment depression in the 12-lead ECGs.

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Section: Discussionmentioning

confidence: 99%

“…Contrary to prominent R-waves, giant neg T wave is attributed to opposite vectorial orientation away from the cardiac apex. Neg T wave and ST-segment 8 depression is considered a secondary phenomenon to the R-waves [26,27] .…”

Section: Discussionmentioning

confidence: 99%

Usefulness of ECG to differentiate apical hypertrophic cardiomyopathy from non-ST elevation acute coronary syndrome

Tao

Bako

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…These voltage criteria of ApHCM may be related to both LV hypertrophy and differences in localized wall thickness leading to disparities in the duration of repolarization. ApHCM is characterized by circular LV hypertrophy, while in NSTEACS, LV hypertrophy presented at the opposite side of the myocardium because of cardiac remodeling, thus it is not a circular hypertrophy [26]. In ApHCM, the mechanism for enormous R waves, dramatically in V3-V4 leads, is due to the apical distribution of hypertrophy opposite to the non-muscular elements of the fibrous cardiac skeleton of the mitral valve and annular plane.…”

Section: Discussionmentioning

confidence: 99%

“…Contrary to prominent R-waves, giant neg T waves isattributed to opposite vectorial orientation away from the cardiac apex. Neg T wave and dep ST-segment is considered a secondary phenomenon to high R-wave [26,27].…”

Section: Discussionmentioning

confidence: 99%

Usefulness of ECG to differentiate apical hypertrophic cardiomyopathy from non-ST elevation acute coronary syndrome

Tao

Bako

et al. 2020

BMC Cardiovasc Disord

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Background: Apical hypertrophic cardiomyopathy (ApHCM) is a phenotypic variant of nonobstructive HCM. ApHCM is characterized by left ventricular hypertrophy involve the distal apex. The electrocardiographic character of ApHCM can mimic non-ST elevation acute coronary syndrome (NSTEACS), triggering a series of studies and treatments that may be unnecessary. This study aimed to clarify the electrocardiogram (ECG) differences between the two diseases. Methods: Initial ECG recordings of 41 patients with ApHCM and 72 patients with NSTEACS were analyzed retrospectively. We analyzed the voltage of negative T (neg T) and R wave, the change of ST-segment as well as the number of leads with neg T wave in the 12-lead ECGs. Results: Across the 12-lead ECGs, the magnitude of R wave significantly differed between ApHCM and NSTEACS in 10 leads excluding leads aVR and V1. ApHCM was associated with a greater maximal amplitude of R wave in lead V5 (3.13 ± 1.08 vs. 1.38 ± 0.73 mV, P < 0.001). The magnitude of T wave significantly differed between ApHCM and NSTEACS in 10 leads excluding leads II and V1. ApHCM was associated with a greater maximal amplitude of neg T wave in lead V4 (0.85 ± 0.69 vs. 0.35 ± 0.23 mV, P < 0.001). The frequency of giant neg T (1mv or more) wave was higher in ApHCM (36.5% vs. 0%, P < 0.001). The magnitude of ST-segment deviation significantly differed between ApHCM and NSTEACS in 10 leads excluding leads aVF and V2. ApHCM was associated with a greater maximal amplitude of STsegment depression in lead V5 (0.19 ± 0.07 vs. 0.03 ± 0.06 mV, P < 0.001). The number of leads with neg T wave also differed between ApHCM and NSTEACS (6.75 ± 1.42 vs. 6.08 ± 1.51, P = 0.046). The sum of R wave in lead V5, neg T wave in lead V6 and ST-segment depression in lead V4 > 2.585 mV identified ApHCM with 90.2% sensibility and 87.5% specificity, representing the highest diagnostic accuracy. Conclusions: Compared with NSTEACS patients, ApHCM patients presented higher R and neg T wave voltage as well as a greater ST-segment depression in the 12-lead ECG. The ECG characteristics can help to differentiate ApHCM from NSTEACS in clinical setting.

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A change of heart: Transformation of the electrocardiogram in a patient with apical hypertrophic cardiomyopathy

Gold

Madias

2020

The American Journal of Emergency Medicine

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Progression of electrocardiographic changes in a patient with apical hypertrophic cardiomyopathy

Cited by 5 publications

References 4 publications

Usefulness of ECG to differentiate apical hypertrophic cardiomyopathy from non-ST elevation acute coronary syndrome

Usefulness of ECG to differentiate apical hypertrophic cardiomyopathy from non-ST elevation acute coronary syndrome

Usefulness of ECG to differentiate apical hypertrophic cardiomyopathy from non-ST elevation acute coronary syndrome

A change of heart: Transformation of the electrocardiogram in a patient with apical hypertrophic cardiomyopathy

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