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Assessment of ECG as a screening tool for Hypertrophic Cardiomyopathy: Adequacy and Phenotypic correlations
Session:
Sessão de Posters 45 - Miocardiopatia hipertrófica
Speaker:
Isabel Maria Martins Moreira
Congress:
CPC 2024
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
17. Myocardial Disease
Subtheme:
17.4 Myocardial Disease – Treatment
Session Type:
Cartazes
FP Number:
---
Authors:
Isabel Martins Moreira; Catarina Ribeiro Carvalho; Marta Catarina Bernardo; Luís Sousa Azevedo; Pedro Rocha Carvalho; Catarina Ferreira; Sara Borges; Inês Silveira; Ilídio Moreira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction: </strong>Despite substantial advances in cardiac imaging and genetics, the electrocardiogram (ECG) remains pivotal in the initial assessment of patients with hypertrophic cardiomyopathy (HCM), family screening and preparticipation sports screening programs. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose: </strong>This study aims to reassess the efficacy of ECG as a screening tool for HCM and explore its correlation with phenotypic expression.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong> A retrospective analysis was conducted on patients monitored at our centre’s cardiomyopathy outpatient clinic. Patients with a confirmed diagnosis of HCM were included, and their initial ECG, clinical and imaging data were reviewed. ECG interpretation was performed using international criteria.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong> A total of 88 HCM patients were identified, mostly male (63.6%), with a mean age at diagnosis of 58±16 years. In the baseline ECG, T-wave inversion was the most prevalent abnormality (55.7%) and 43% of patients displayed left ventricular hypertrophy (LVH) voltage criteria. Seven patients (8%) had a normal ECG and 28.4% only exhibited nonspecific ventricular repolarization abnormalities. Most patients presented in sinus rhythm (88.6%), while 10.2% were in atrial fibrillation.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">In the initial echocardiography, median left ventricular ejection fraction (LVEF) was 65.2±11% and mean interventricular septum thickness was 15.9±4.0mm. Obstructive phenotype was identified in 19.3% of patients and apical variant was observed in 20.4%. </span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Cardiac magnetic resonance was performed at a median time of 8 months of follow-up (IQR 3-51) and revealed maximal wall thickness of 17.3±3.7mm and late gadolinium enhancement in 72.2% patients. Genetic testing revealed pathogenic sarcomere protein gene mutations in 14 patients.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">T-wave inversion and LVH criteria on ECG were more prevalent in apical variants (p<0.001 and p=0.005, respectively), while non-apical variants exhibited higher prevalence of pathologic Q waves (p=0.005). Similar findings were noted in ECG patterns between sarcomere and non-sarcomere patients and in patients with or without family history of HCM. </span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">No statistically significant differences were found between mean maximal wall thickness on echocardiography and LVH criteria (p=0.789), T-wave inversion (p=0.253), and normal ECG (p=0.247).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion: </strong>ECG continues to play an important role in HCM screening and diagnosis. In our study, 92% of HCM patients had abnormalities on initial ECG, particularly T-wave inversion and LVH criteria. However, these abnormalities do not consistently correlate with the severity or pattern of hypertrophy on echocardiography.</span></span></p>
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