Morphological and Electrical Characteristics in Patient with Hypertrophic Cardiomyopathy: Quantitative Analysis of 864 Korean Cohort
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Purpose: Although several studies have reported the morphological and electrical characteristics in patients with hypertrophic cardiomyopathy (HCM), comparison between asymmetric and apical HCM has not been investigated in a reasonably sized cohort. Materials and Methods: Echocardiography and electrocardiography were quantitatively analyzed in patients with HCM in a Koreantertiary referral center. Results: Of 864 patients (mean age 55.4±14.2 years, 68.9% men), 255 (29.5%) patients had apical HCM, 553 (64.0%) patients asymmetricHCM, and 56 (6.4%) patients mixed type HCM. In echocardiographic evaluations, about three quarters of patients (75.8%) had left atrial enlargement. Left ventricular (LV) dilatations and systolic dysfunction were observed in 6.1% and 2.4%, respectively. QRS widening, PR prolongation, and pathologic Q wave are frequent in patients with asymmetric HCM, while LV strain is frequentin patient with apical HCM. The prevalence of J-point elevations (9.4% in inferior, 2.2% in lateral leads) were substantially higher than that in general population. Giant negative T wave was observed in 15.0% of total patients (32.2% in apical, 6.2% in asymmetric,25% in mixed type). There was no significant correlation between the thickness of the apical wall and the amplitude of T wave inversion (r=-0.005, p=0.71). Conclusion: In a large cohort of HCM including apical type, repolarization abnormalities, including early repolarization and QT prolongation as well as LV strain, were significantly observed. T wave inversion was not appropriate for screening of HCM and not correlated with apical wall thickness.
Abstract
Purpose: Although several studies have reported the morphological and electrical characteristics in patients with hypertrophic cardiomyopathy (HCM), comparison between asymmetric and apical HCM has not been investigated in a reasonably sized cohort. Materials and Methods: Echocardiography and electrocardiography were quantitatively analyzed in patients with HCM in a Koreantertiary referral center. Results: Of 864 patients (mean age 55.4±14.2 years, 68.9% men), 255 (29.5%) patients had apical HCM, 553 (64.0%) patients asymmetricHCM, and 56 (6.4%) patients mixed type HCM. In echocardiographic evaluations, about three quarters of patients (75.8%) had left atrial enlargement. Left ventricular (LV) dilatations and systolic dysfunction were observed in 6.1% and 2.4%, respectively. QRS widening, PR prolongation, and pathologic Q wave are frequent in patients with asymmetric HCM, while LV strain is frequentin patient with apical HCM. The prevalence of J-point elevations (9.4% in inferior, 2.2% in lateral leads) were substantially higher than that in general population. Giant negative T wave was observed in 15.0% of total patients (32.2% in apical, 6.2% in asymmetric,25% in mixed type). There was no significant correlation between the thickness of the apical wall and the amplitude of T wave inversion (r=-0.005, p=0.71). Conclusion: In a large cohort of HCM including apical type, repolarization abnormalities, including early repolarization and QT prolongation as well as LV strain, were significantly observed. T wave inversion was not appropriate for screening of HCM and not correlated with apical wall thickness.
참고문헌 (41)
- Abbasi AS, "Echocardiographic diagnosis of idiopathic hypertrophic cardiomyopathy without outflow obstruction", Circulation, 46, pp.897~904 (1972)
- Henry WL, "Asymmetric septal hypertrophy. Echocardiographic identification of the pathognomonic anatomic abnormality of IHSS", Circulation, 47, pp.225~233 (1973)
- Pridie RB, "Mitral valve movement in hypertrophic obstructive cardiomyopathy", Br Heart J, 31, pp.390~ (1969)
- Sakamoto T, "Giant T wave inversion as a manifestation of asymmetrical apical hypertrophy (AAH) of the left ventricle. Echocardiographic and ultrasono-cardiotomographic study", Jpn Heart J, 17, pp.611~629 (1976)
- Klues HG, "Phenotypic spectrum and patterns of left ventricular hypertrophy in hypertrophic cardiomyopathy:morphologic observations and significance as assessed by two-dimensional echocardiography in 600 patients", J Am Coll Cardiol, 26, pp.1699~1708 (1995)
- Maron BJ, "Relation of electrocardiographic abnormalities and patterns of left ventricular hypertrophy identified by 2-dimensional echocardiography in patients with hypertrophic cardiomyopathy", Am J Cardiol, 51, pp.189~194 (1983)
- Savage DD, "Electrocardiographic findings in patients with obstructive and nonobstructive hypertrophic cardiomyopathy", Circulation, 58(3 Pt 1), pp.402~408 (1978)
- Prescott R, "Electrocardiographic changes in hypertrophic subaortic stenosis which simulate myocardial infarction", Am Heart J, 66, pp.42~48 (1963)
- Cosio FG, "The Q waves hypertrophic cardiomyopathy: an electrophysiologic study", N Engl J Med, 302, pp.96~99 (1980)
- Maron BJ, "The 50-year history, controversy, and clinical implications of left ventricular outflow tract obstruction in hypertrophic cardiomyopathy from idiopathic hypertrophic subaortic stenosis to hypertrophic cardiomyopathy:from idiopathic hypertrophic subaortic stenosis to hypertrophic cardiomyopathy", J Am Coll Cardiol, 54, pp.191~200 (2009)
- Maron BJ, "American College of Cardiology", European Society of Cardiology clinical expert consensus document on hypertrophic cardiomyopathy. A report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents and the European Society of Cardiology Committee for Practice Guidelines, 2003, pp.42, 1687~1713
- Yamaguchi H, "Hypertrophic nonobstructive cardiomyopathy with giant negative T waves (apical hypertrophy): ventriculographic and echocardiographic features in 30 patients", Am J Cardiol, 44, pp.401~412 (1979)
- Chikamori T, "Comparison of clinical, morphological, and prognostic features in hypertrophic cardiomyopathy between Japanese and western patients", Clin Cardiol, 15, pp.833~837 (1992)
- Kim SH, "Longterm comparison of apical versus asymmetric hypertrophic cardiomyopathy", Int Heart J, 54, pp.207~211 (2013)
- Eriksson MJ, "Long-term outcome in patients with apical hypertrophic cardiomyopathy", J Am Coll Cardiol, 39, pp.638~645 (2002)
- Otto CM, "The practice of clinical echocardiography", pp.589~ (2002), W.B. Saunders
- Feigenbaum H, "Feigenbaum’s echocardiography", pp.545~ (2005), Lippincott Williams & Wilkins
- Romhilt DW, "A critical appraisal of the electrocardiographic criteria for the diagnosis of left ventricular hypertrophy", Circulation, 40, pp.185~195 (1969)
- Wagner GS, "Marriott’s practical electrocardiography", pp.90~93 (2001), Lippincott Williams & Wilkins
- Maron BJ, "Prevalence of hypertrophic cardiomyopathy in a general population of young adults. Echocardiographic analysis of 4111 subjects in the CARDIA Study. Coronary Artery Risk Development in (Young) Adults", Circulation, 92, pp.785~789 (1995)
- Brock R, "Functional obstruction of the left ventricle; acquired aortic subvalvar stenosis", Guys Hosp Rep, 106, pp.221~238 (1957)
- Teare D, "Asymmetrical hypertrophy of the heart in young adults", Br Heart J, 20, pp.1~8 (1958)
- Braunmald E, "Idiopathic hypertrophic subaortic stenosis. I. A description of the disease based upon an analysis of 64 patients", Circulation, 30(Suppl 4), pp.3~119 (1964)
- Maron BJ, "Hypertrophic cardiomyopathy. Interrelations of clinical manifestations, pathophysiology, and therapy (2)", N Engl J Med, 316, pp.844~852 (1987)
- Maron BJ, "Hypertrophic cardiomyopathy: a systematic review", JAMA, 287, pp.1308~1320 (2002)
- Louie EK, "Apical hypertrophic cardiomyopathy: clinical and two-dimensional echocardiographic assessment", Ann Intern Med, 106, pp.663~670 (1987)
- Ho CY, "Assessment of diastolic function with Doppler tissue imaging to predict genotype in preclinical hypertrophic cardiomyopathy", Circulation, 105, pp.2992~2997 (2002)
- Maron BJ, "Noninvasive assessment of left ventricular diastolic function by pulsed Doppler echocardiography in patients with hypertrophic cardiomyopathy", J Am Coll Cardiol, 10, pp.733~742 (1987)
- Maron BJ, "Implications of left ventricular remodeling in hypertrophic cardiomyopathy", Am J Cardiol, 81, pp.1339~1344 (1998)
- Spirito P, "Occurrence and significance of progressive left ventricular wall thinning and relative cavity dilatation in hypertrophic cardiomyopathy", Am J Cardiol, 60, pp.123~129 (1987)
- Hina K, "Progression of left ventricular enlargement in patients with hypertrophic cardiomyopathy: incidence and prognostic value", Clin Cardiol, 16, pp.403~407 (1993)
- Tsunakawa H, "Study on the genesis of giant negative T wave in apical hypertrophic cardiomyopathy using a three-dimensional computer model", Jpn Heart J, 32, pp.799~809 (1991)
- Rowin EJ, "Significance of false negative electrocardiograms in preparticipation screening of athletes for hypertrophic cardiomyopathy", Am J Cardiol, 110, pp.1027~1032 (2012)
- Lakdawala NK, "Electrocardiographic features of sarcomere mutation carriers with and without clinically overt hypertrophic cardiomyopathy", Am J Cardiol, 108, pp.1606~1613 (2011)
- Park SY, "Relationship between giant negative T-wave and severity of apical hypertrophy in patients with apical hypertrophic cardiomyopathy", Echocardiography, 27, pp.770~776 (2010)
- Tikkanen JT, "Long-term outcome associated with early repolarization on electrocardiography", N Engl J Med, 361, pp.2529~2537 (2009)
- Jeong Joon Hoon, "Prevalence of and Risk Factors for Atrial Fibrillation in Korean Adults Older than 40 Years", Journal of Korean Medical Science, 20(1), pp.26~30 (2005), 대한의학회
- Iguchi Y, "Prevalence of atrial fibrillation in community-dwelling Japanese aged 40 years or older in Japan: analysis of 41,436 non-employee residents in Kurashiki-city", Circ J, 72, pp.909~913 (2008)
- Lok NS, "Prevalence of palpitations, cardiac arrhythmias and their associated risk factors in ambulant elderly", Int J Cardiol, 54, pp.231~236 (1996)
- Go AS, "Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study", JAMA, 285, pp.2370~2375 (2001)
- Olivotto I, "Impact of atrial fibrillation on the clinical course of hypertrophic cardiomyopathy", Circulation, 104, pp.2517~2524 (2001)
