Relationship between electrocardiographic findings and Cardiac Magnetic Resonance phenotypes in patients with Hypertrophic Cardiomyopathy

Fronza, Matteo; Raineri, Claudia; Valentini, Adele; Bassi, Ernesto; Buscemi, M; Turco, Annalisa; Castelli, G; Ghio, Stefano; Visconti, Luigi Oltrona

doi:10.1016/j.ijcha.2016.02.001

Cited by 13 publications

(11 citation statements)

References 26 publications

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“…Parallel with our study, previous studies have also demonstrated that myocardial fibrosis detected as late gadolinium enhancement (LGE) in MRI correlates with fragmented QRS complex, ECG strain and T wave inversions 21–25. The association between LGE and pathological Q waves in hypertrophic cardiomyopathy patients has not been as congruent in previous studies 25 26. However, LGE can detect only regional fibrosis patterns, and ECG characteristics of diffuse fibrosis are less well studied.…”

Section: Discussionsupporting

confidence: 54%

Electrocardiographic associations with myocardial fibrosis among sudden cardiac death victims

Holmström

Haukilahti

Vähätalo

et al. 2020

Heart

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ObjectiveA major challenge in reducing the incidence of sudden cardiac death (SCD) is the identification of patients at risk. Myocardial fibrosis has a substantial association with SCD risk but is difficult to identify among general populations. Our aim was to find electrocardiographic (ECG) markers of myocardial fibrosis among SCD victims.MethodsStudy population was acquired from the Fingesture study, which has gathered data from 5869 consecutive autopsied SCD victims in Northern Finland between 1998 and 2017. The degree of fibrosis was determined in histological samples taken from the heart during autopsy and was categorised into four groups: (1) no fibrosis, (2) scattered mild fibrosis, (3) moderate patchy fibrosis and (4) substantial fibrosis. We were able to collect ECGs from 1100 SCD victims.ResultsThe mean age of the study subjects was 66±13 years and 75% were male. QRS duration in ECG correlated with the degree of fibrosis (p<0.001, β=0.153). Prevalence of fragmented QRS complex, pathological Q waves and T wave inversions correlated with increased degree of fibrosis (p<0.001 in each). Depolarisation abnormalities were observed both in ischaemic and non-ischaemic heart disease. Repolarisation abnormalities reached statistical significance only among ischaemic SCD victims. An abnormal ECG was observed in 75.3% of the subjects in group 1, 73.7% in group 2, 88.5% in group 3 and 91.7% in group 4 patients (p<0.001).ConclusionsMyocardial fibrosis was associated with QRS prolongation, deep Q waves, T wave inversions and QRS fragmentation. The results provide potentially useful non-invasive early recognition of patients with fibrotic cardiomyopathy and risk of SCD.

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Section: Discussionsupporting

confidence: 54%

Electrocardiographic associations with myocardial fibrosis among sudden cardiac death victims

Holmström

Haukilahti

Vähätalo

et al. 2020

Heart

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“…18 Furthermore, it was suggested that regional negative T waves correlate with regional scarring demonstrated by late gadolinium enhancement on cardiac MRI. 19 This would suggest that presence of scarring in the lateral wall is less present in genotype positive HCM.…”

Section: Discussionmentioning

confidence: 99%

Clinical and ECG variables to predict the outcome of genetic testing in hypertrophic cardiomyopathy

Robyns

Breckpot²,

Nuyens

et al. 2020

European Journal of Medical Genetics

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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“…4). Fibrosis 39 , diabetes 40 , or hypertrophy 41 are main risk factors potentially affecting cell coupling and consequently decreasing myocardial conduction, albeit with unclear ECG signature 42 . In our simulations, slow conduction promoted reentry in acute regional ischemia.…”

Section: Discussionmentioning

confidence: 99%

High arrhythmic risk in antero-septal acute myocardial ischemia is explained by increased transmural reentry occurrence

Martinez-Navarro

Mincholé

Bueno‐Orovio

et al. 2019

Sci Rep

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Acute myocardial ischemia is a precursor of sudden arrhythmic death. Variability in its manifestation hampers understanding of arrhythmia mechanisms and challenges risk stratification. Our aim is to unravel the mechanisms underlying how size, transmural extent and location of ischemia determine arrhythmia vulnerability and ECG alterations. High performance computing simulations using a human torso/biventricular biophysically-detailed model were conducted to quantify the impact of varying ischemic region properties, including location (LAD/LCX occlusion), transmural/subendocardial ischemia, size, and normal/slow myocardial propagation. ECG biomarkers and vulnerability window for reentry were computed in over 400 simulations for 18 cases evaluated. Two distinct mechanisms explained larger vulnerability to reentry in transmural versus subendocardial ischemia. Macro-reentry around the ischemic region was the primary mechanism increasing arrhythmic risk in transmural versus subendocardial ischemia, for both LAD and LCX occlusion. Transmural micro-reentry at the ischemic border zone explained arrhythmic vulnerability in subendocardial ischemia, especially in LAD occlusion, as reentries were favoured by the ischemic region intersecting the septo-apical region. ST elevation reflected ischemic extent in transmural ischemia for LCX and LAD occlusion but not in subendocardial ischemia (associated with mild ST depression). The technology and results presented can inform safety and efficacy evaluation of anti-arrhythmic therapy in acute myocardial ischemia.

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Relationship between electrocardiographic findings and Cardiac Magnetic Resonance phenotypes in patients with Hypertrophic Cardiomyopathy

Cited by 13 publications

References 26 publications

Electrocardiographic associations with myocardial fibrosis among sudden cardiac death victims

Electrocardiographic associations with myocardial fibrosis among sudden cardiac death victims

Clinical and ECG variables to predict the outcome of genetic testing in hypertrophic cardiomyopathy

High arrhythmic risk in antero-septal acute myocardial ischemia is explained by increased transmural reentry occurrence

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