The association between T wave inversion and apical hypertrophic cardiomyopathy

Abstract

Apical hypertrophic cardiomyopathy was first reported by Sakamoto of Japan in 1976. 1 As one of the hypertrophic cardiomyopathies, it is characterized by myocardial hypertrophy limited to the left ventricular apex, a giant T wave inversion (T wave inversion ≥ 10 mm) in precordial leads, and a spade shape at the end of diastolic phase of left ventricle due to severe hypertrophy of the left ventricle. 2 According to recent guidelines, it is indicated by a myocardial thickness greater than Kosin Medical Journal 2018;33:328-336. Objectives: Electrocardiograhy (ECG) is the first step in hypertrophic cardiomyopathy (HCMP) diagnosis. For various reasons, the T wave inversion (TWI) and ECG change with time and HCMP is not easy to diagnosis. The aim of this retrospective study was to investigate the association between TWI on ECG and apical HCMP. Methods: A total of 4,730 ECGs presenting TWI from January 2011 to March 2013 in Pusan National University Hospital were enrolled. 133 patients who were examined by both echocardiography and coronary angiogram were analyzed. Patients were divided into two groups: Group A (TWI ≥ 10 mm) and Group B (5 mm ≤ TWI < 10 mm). HCMP is defined by a wall thickness ≥ 15mm in one or more LV myocardial segments. Apical HCMP is defined to be hypertrophy that is confined to LV apex. The patients who had ECGs with at least one month interval were divided 3 groups: Normal T wave, Abnormal T wave, and Persistent TWI. The prevalence of Apical HCMP and coronary artery disease (CAD) was reviewed among the three groups. Results: In this study there were a total 133 patients, with patients divided into Group A which had 15 patients and Group B which had 118 patients. Among the 23 patients with apical HCMP, three patients were Group A and twenty patients were Group B (P = 0.769). Regarding constancy of TWI, persistent TWI group was higher in apical HCMP than in other groups (P = 0.038). CAD had no difference between groups (P = 0.889). Conclusions: T wave negativity was not associated with incidence of apical HCMP. However, apical HCMP was diagnosed more frequently in patients with persistent TWI. Further follow up echocardiographic study is needed to evaluate the progression of apical HCMP in patients with TWI.

The prevalence and clinical importance of isolated inverted T wave in precordial leads

“…Furthermore, as normal coronary angiography may not rule out myocardial ischemia, diagnosis of the underlying cause of inverted T-wave may become confusing for cardiologists (1). For this reason, it is necessary for patients to detect the inverted T wave, which is most associated with cardiovascular complications, to prevent additional interventions and also to avoid time delay in performing appropriate diagnostic and therapeutic measures.…”