Relation of electrocardiographic abnormalities and patterns of left ventricular hypertrophy identified by 2-dimensional echocardiography in patients with hypertrophic cardiomyopathy

doi:10.1016/S0002-9149(83)80034-4

The American Journal of Cardiology

Volume 51, Issue 1, 1 January 1983, Pages 189-194

https://doi.org/10.1016/S0002-9149(83)80034-4 Get rights and content

Distribution of left ventricular (LV) hypertrophy was assessed by wide-angle, 2-dimensional (2-D) echocardiography in 153 patients with hypertrophic cardiomyopathy and compared with the scalar electrocardiogram in the same patients. The most common electrocardiographic alterations were S-T segment changes and T-wave inversion (61%), LV hypertrophy (47%), abnormal Q waves (25%), and left atrial enlargement (24%). LV hypertrophy on the electrocardiogram was significantly more common in patients with the most extensive distribution of LV hypertrophy on 2-D echocardiogram involving substantial portions of both the ventricular septum and LV free wall (type III; 51 of 69, 74%) than in those with more limited distribution of LV hypertrophy (21 of 84, 25%; p <0.001). Most patients with hypertrophic cardiomyopathy and normal electrocardiograms (13 of 23) had localized (type I) hypertrophy, but only 4 had the extensive type III pattern of hypertrophy.

Abnormal Q waves were significantly more common in those patients without hypertrophy of the anterior, basal septum (type IV; 15 of 27, 56%) than in those with basal septal hypertrophy (23 of 126, 18%; p <0.001); abnormal Q waves were uncommon in extensive type III distribution of hypertrophy (13 of 69, 19%).

Thus, although no single electrocardiographic abnormality is characteristic of hypertrophic cardiomyopathy, 2-D echocardiography clarifies the significance of certain electrocardiographic patterns: (1) LV hypertrophy on the electrocardiogram, although present in only about half of the study group, was a relatively sensitive (74%) marker for extensive (type III) LV hypertrophy; (2) abnormal Q waves cannot be explained by ventricular septal hypertrophy alone; and (3) a normal electrocardiogram was most commonly a manifestation of localized LV hypertrophy.

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The relationships between electrocardiography (ECG) findings and echocardiographic profiles in patients with hypertrophic cardiomyopathy (HCM) are not fully understood.
One hundred forty patients (mean age: 62.9 ± 15.3 years, 96 men) with HCM were studied. We assessed the associations between ECG findings and echocardiographic findings including maximum left ventricular wall thickness, HCM subtypes and distribution of left ventricular hypertrophy (LVH): the LV was divided into basal, mid, and apical segments by dividing it into thirds along the long axis.
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Full English text available from: www.revespcardiol.org/en

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Relation of electrocardiographic abnormalities and patterns of left ventricular hypertrophy identified by 2-dimensional echocardiography in patients with hypertrophic cardiomyopathy

Chest

Am J Cardiol

Am J Cardiol

Am J Cardiol

Idiopathic hypertrophic subaortic stenosis: clinical analysis of 126 patients with emphasis on the natural history

Circulation

Electrocardiographic abnormalities in hypertrophic cardiomyopathy: relation to cardiac hypertrophy and intraventricular obstruction (abstr)

Circulation

Disparity between echocardiographic and electrocardiographic findings in asymmetric septal hypertrophy (abstr)

Clin Res

Electrocardiographic findings in patients with obstructive and nonobstructive hypertrophic cardiomyopathy

Circulation

Hypertrophic cardiomyopathy with unusual locations of left ventricular hypertrophy undetectable by M-mode echocardiography: identification by wide-angle two-dimensional echocardiography

Circulation

Nomenclature and Criteria for Diagnosis of Diseases of The Heart and Great Vessels

Echocardiographic measurement of left ventricular outflow gradient in idiopathic hypertrophic subaortic stenosis

N Engl J Med

Asymmetric septal hypertrophy (ASH): echocardiographic identification of the pathognomonic anatomic abnormality of IHSS

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Circulation