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ECG changes and left ventricular hypertrophy criteria in hypertrophic cardiomyopathy phenotypes
Session:
Painel 9 - Doença Valvular 7
Speaker:
Inês Sofia Pereira Oliveira
Congress:
CPC 2020
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
17. Myocardial Disease
Subtheme:
17.3 Myocardial Disease – Diagnostic Methods
Session Type:
Posters
FP Number:
---
Authors:
Inês Pereira Oliveira; Ana Leal Neto; Isabel Martins Da Cruz; Daniel Seabra De Carvalho; Rui Pontes dos Santos; João A. G. Azevedo; Aurora Andrade; Paula Pinto
Abstract
<p><strong>Introduction: </strong>Hypertrophic cardiomyopathy (HCM) is defined by the presence of increased left ventricular (LV) wall thickness (LVWT) that is not solely explained by abnormal loading conditions. The standard 12-lead ECG can be normal at presentation but generally shows a variable combination of LV hypertrophy (LVH), ST- and T-wave abnormalities, and pathological Q-waves. LVH is mainly determined by an increase in LV mass, which can be estimated by the electrical voltage changes detected on the surface ECG. </p> <p><strong>Purpose: </strong>To characterize a cohort of HCM patients (pts) who underwent cardiac magnetic resonance (CMR) and identify ECG and imaging differences between HCM phenotypes. </p> <p><strong>Methods: </strong>Unicentric, retrospective analysis of pts with HCM diagnosis who underwent CMR between 1/2013 and 9/2019. Patients (pts) were compared according to 3 phenotypes: non-obstructive (G1), obstructive (G2) or apical phenotype (G3). ECG and imagiological features were analysed. Three LVH criteria were measured: Sokolow-Lyon voltage criteria (S wave in V1 plus the R wave in V5 or V6), modified Cornell Criteria (R wave in aVL) and Peguero-Lo Presti criteria (deepest S wave in any lead and S wave in V4). Each criterion was evaluated on different phenotypes and assessed whether if it met criteria for LVH. </p> <p><strong>Results:</strong> Out of the 781 CMR studies evaluated, 59 pts were found to have HCM (7.6%) with a mean age of 62.1 ± 11.4 years. G1 had 35 pts (59.3%), G2 12 pts (20.3%) and G3 12 pts (20.3%). G3 pts had lower prevalence of strain pattern (G3 8.3% vs G2 50.0% vs G1 38.2%, p=0.037), but higher prevalence of negative T wave inversion (G3 83.3% vs G2 8.3% vs G1 38.2%, p<0.001). There were no differences between groups regarding Sokolow-Lyon criteria nor modified Cornell Criteria. G1 had higher prevalence of Peguero-Lo Presti LVH criteria (G1 74.3% vs G2 50.0% vs G3 16.7%; p=0.002). G2 pts had higher LV mass (G2 104.5 ± 25.5g/m<sup>2</sup>, p=0.002), and higher LV mass was associated with strain pattern on ECG (p=0.021). </p> <p><strong>Conclusion: </strong>In this cohort, apical HCM phenotype had higher prevalence of negative T wave inversion on ECG. On the other hand, strain pattern and Peguero-Lo Presti LVH criteria correlated better with non-apical HCM phenotypes as well as with a higher LV mass measured by CMR. </p>
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