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Erschienen in: The International Journal of Cardiovascular Imaging 10/2018

04.05.2018 | Original Paper

Electrocardiography based prediction of hypertrophy pattern and fibrosis amount in hypertrophic cardiomyopathy: comparative study with cardiac magnetic resonance imaging

verfasst von: Chul Hwan Park, Hyemoon Chung, Yoonjung Kim, Jong-Youn Kim, Pil-Ki Min, Kyung-A. Lee, Young Won Yoon, Tae Hoon Kim, Byoung Kwon Lee, Bum-Kee Hong, Se-Joong Rim, Hyuck Moon Kwon, Eui-Young Choi

Erschienen in: The International Journal of Cardiovascular Imaging | Ausgabe 10/2018

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Abstract

Although, cardiac magnetic resonance imaging (CMR) is a gold standard for risk stratification of hypertrophic cardiomyopathy (HCM), is limited in some situations. We sought to evaluate the predictive power of quantitative electrocardiography in assessing hypertrophy pattern and fibrosis in HCM. Eighty-eight patients with HCM were studied. Voltage of R–S–T waves, number of fragmented QRS (fQRS) complexes, and T wave morphology were measured by 12-lead electrocardiography. Sixteen segmental thickness, late gadolinium enhancement (LGE), native T1, extracellular volume fraction (ECV), and T2, left ventricular (LV) mass and %LGE were measured by CMR. Patterns of LV hypertrophy were classified as pure apical, mixed, or asymmetrical septal hypertrophy. Positive and negative predictive values of biphasic T wave for pure apical type were 70.4 and 63.9%, and the predictive values of precordial negative T wave sums \(>\) 12.5 mm were 69.2 and 79.6%. Precordial S waves, especially Cornell voltage index, were significantly correlated to LV mass index and maximal thickness (p \(<\hspace{0.17em}\)0.001). The number of fQRS leads was significantly correlated to %LGE, average ECV, and T2 (all p \(<\hspace{0.17em}\)0.001). More than one lead with fQRS could predict \(>\hspace{0.17em}\)5% of LGE mass with 58% sensitivity and 63% specificity (p = 0.049, area under the curve = 0.627). However, degree of correlation between maximal thickness and precordial S was poor in cases with fQRS more two leads. T wave morphology and precordial S helps discriminate hypertrophy pattern and maximal hypertrophy, however, in cases with more than two leads of concomitant fQRS, CMR defines fibrosis amount and hypertrophy more accurately.
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Literatur
1.
Zurück zum Zitat Elliott PM, Anastasakis A, Borger MA, Borggrefe M, Cecchi F, Charron P et al (2014) ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J 35(39):2733–2779CrossRef Elliott PM, Anastasakis A, Borger MA, Borggrefe M, Cecchi F, Charron P et al (2014) ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J 35(39):2733–2779CrossRef
2.
Zurück zum Zitat Papavassiliu T, Schnabel P, Schroder M, Borggrefe M (2005) CMR scarring in a patient with hypertrophic cardiomyopathy correlates well with histological findings of fibrosis. Eur Heart J 26:22CrossRef Papavassiliu T, Schnabel P, Schroder M, Borggrefe M (2005) CMR scarring in a patient with hypertrophic cardiomyopathy correlates well with histological findings of fibrosis. Eur Heart J 26:22CrossRef
3.
Zurück zum Zitat Todiere G, Aquaro GD, Piaggi P, Formisano F, Barison A, Masci PG et al (2012) Progression of myocardial fibrosis assessed with cardiac magnetic resonance in hypertrophic cardiomyopathy. J Am Coll Cardiol 60(10):922–929CrossRef Todiere G, Aquaro GD, Piaggi P, Formisano F, Barison A, Masci PG et al (2012) Progression of myocardial fibrosis assessed with cardiac magnetic resonance in hypertrophic cardiomyopathy. J Am Coll Cardiol 60(10):922–929CrossRef
4.
Zurück zum Zitat Wagner GS, Macfarlane P, Wellens H, Josephson M, Gorgels A, Mirvis DM et al (2009) AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part VI: acute ischemia/infarction: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society. Endorsed by the International Society for Computerized Electrocardiology. J Am Coll Cardiol 53(11):1003–1011CrossRef Wagner GS, Macfarlane P, Wellens H, Josephson M, Gorgels A, Mirvis DM et al (2009) AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part VI: acute ischemia/infarction: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society. Endorsed by the International Society for Computerized Electrocardiology. J Am Coll Cardiol 53(11):1003–1011CrossRef
5.
Zurück zum Zitat Konno T, Nagata Y, Teramoto R, Fujino N, Nomura A, Tada H et al (2016) Usefulness of electrocardiographic voltage to determine myocardial fibrosis in hypertrophic cardiomyopathy. Am J Cardiol 117(3):443–449CrossRef Konno T, Nagata Y, Teramoto R, Fujino N, Nomura A, Tada H et al (2016) Usefulness of electrocardiographic voltage to determine myocardial fibrosis in hypertrophic cardiomyopathy. Am J Cardiol 117(3):443–449CrossRef
6.
Zurück zum Zitat Fronza M, Raineri C, Valentini A, Bassi EM, Scelsi L, Buscemi ML et al (2016) Relationship between electrocardiographic findings and cardiac magnetic resonance phenotypes in patients with hypertrophic cardiomyopathy. IJC Heart Vasculature 11:7–11CrossRef Fronza M, Raineri C, Valentini A, Bassi EM, Scelsi L, Buscemi ML et al (2016) Relationship between electrocardiographic findings and cardiac magnetic resonance phenotypes in patients with hypertrophic cardiomyopathy. IJC Heart Vasculature 11:7–11CrossRef
7.
Zurück zum Zitat Hancock EW, Deal BJ, Mirvis DM, Okin P, Kligfield P, Gettes LS et al (2009) AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part V: electrocardiogram changes associated with cardiac chamber hypertrophy: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee. Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society. Endorsed by the International Society for Computerized Electrocardiology. J Am Coll Cardiol 53(11):992–1002CrossRef Hancock EW, Deal BJ, Mirvis DM, Okin P, Kligfield P, Gettes LS et al (2009) AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part V: electrocardiogram changes associated with cardiac chamber hypertrophy: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee. Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society. Endorsed by the International Society for Computerized Electrocardiology. J Am Coll Cardiol 53(11):992–1002CrossRef
8.
Zurück zum Zitat Sakamoto T, Tei C, Murayama M, Ichiyasu H, Hada Y (1976) 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(5):611–629CrossRef Sakamoto T, Tei C, Murayama M, Ichiyasu H, Hada Y (1976) 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(5):611–629CrossRef
9.
Zurück zum Zitat Hanna EB, Glancy DL (2011) ST-segment depression and T-wave inversion: classification, differential diagnosis, and caveats. Cleve Clin J Med 78(6):404–414CrossRef Hanna EB, Glancy DL (2011) ST-segment depression and T-wave inversion: classification, differential diagnosis, and caveats. Cleve Clin J Med 78(6):404–414CrossRef
10.
Zurück zum Zitat Sokolow M, Lyon TP (1949) The ventricular complex in left ventricular hypertrophy as obtained by unipolar precordial and limb leads. Am Heart J 37(2):161–186CrossRef Sokolow M, Lyon TP (1949) The ventricular complex in left ventricular hypertrophy as obtained by unipolar precordial and limb leads. Am Heart J 37(2):161–186CrossRef
11.
Zurück zum Zitat Casale PN, Devereux RB, Alonso DR, Campo E, Kligfield P (1987) Improved sex-specific criteria of left ventricular hypertrophy for clinical and computer interpretation of electrocardiograms: validation with autopsy findings. Circulation 75(3):565–572CrossRef Casale PN, Devereux RB, Alonso DR, Campo E, Kligfield P (1987) Improved sex-specific criteria of left ventricular hypertrophy for clinical and computer interpretation of electrocardiograms: validation with autopsy findings. Circulation 75(3):565–572CrossRef
12.
Zurück zum Zitat Levy D, Labib SB, Anderson KM, Christiansen JC, Kannel WB, Castelli WP (1990) Determinants of sensitivity and specificity of electrocardiographic criteria for left ventricular hypertrophy. Circulation 81(3):815–820CrossRef Levy D, Labib SB, Anderson KM, Christiansen JC, Kannel WB, Castelli WP (1990) Determinants of sensitivity and specificity of electrocardiographic criteria for left ventricular hypertrophy. Circulation 81(3):815–820CrossRef
13.
Zurück zum Zitat Romhilt DW, Estes EH Jr (1968) A point-score system for the ECG diagnosis of left ventricular hypertrophy. Am Heart J 75(6):752–758CrossRef Romhilt DW, Estes EH Jr (1968) A point-score system for the ECG diagnosis of left ventricular hypertrophy. Am Heart J 75(6):752–758CrossRef
14.
Zurück zum Zitat Das MK, Khan B, Jacob S, Kumar A, Mahenthiran J (2006) Significance of a fragmented QRS complex versus a Q wave in patients with coronary artery disease. Circulation 113(21):2495–2501CrossRef Das MK, Khan B, Jacob S, Kumar A, Mahenthiran J (2006) Significance of a fragmented QRS complex versus a Q wave in patients with coronary artery disease. Circulation 113(21):2495–2501CrossRef
15.
Zurück zum Zitat Das MK, Suradi H, Maskoun W, Michael MA, Shen C, Peng J et al (2008) Fragmented wide QRS on a 12-lead ECG: a sign of myocardial scar and poor prognosis. Circ Arrhythm Electrophysiol 1(4):258–268CrossRef Das MK, Suradi H, Maskoun W, Michael MA, Shen C, Peng J et al (2008) Fragmented wide QRS on a 12-lead ECG: a sign of myocardial scar and poor prognosis. Circ Arrhythm Electrophysiol 1(4):258–268CrossRef
16.
Zurück zum Zitat Choi EY, Hwang SH, Yoon YW, Park CH, Paek MY, Greiser A et al (2013) Correction with blood T1 is essential when measuring post-contrast myocardial T1 value in patients with acute myocardial infarction. J Cardiovasc Magn Reson 15(1):11CrossRef Choi EY, Hwang SH, Yoon YW, Park CH, Paek MY, Greiser A et al (2013) Correction with blood T1 is essential when measuring post-contrast myocardial T1 value in patients with acute myocardial infarction. J Cardiovasc Magn Reson 15(1):11CrossRef
17.
Zurück zum Zitat Park CH, Choi EY, Greiser A, Paek MY, Hwang SH, Kim TH (2013) Diagnosis of acute global myocarditis using cardiac MRI with quantitative t1 and t2 mapping: case report and literature review. Korean J Radiol 14(5):727–732CrossRef Park CH, Choi EY, Greiser A, Paek MY, Hwang SH, Kim TH (2013) Diagnosis of acute global myocarditis using cardiac MRI with quantitative t1 and t2 mapping: case report and literature review. Korean J Radiol 14(5):727–732CrossRef
18.
Zurück zum Zitat Cerqueira MD, Weissman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK et al (2002) Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for Healthcare Professionals From the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation 105(4):539–542CrossRef Cerqueira MD, Weissman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK et al (2002) Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for Healthcare Professionals From the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation 105(4):539–542CrossRef
19.
Zurück zum Zitat Moravsky G, Ofek E, Rakowski H, Butany J, Williams L, Ralph-Edwards A et al (2013) Myocardial fibrosis in hypertrophic cardiomyopathy: accurate reflection of histopathological findings by CMR. JACC Cardiovasc Imaging 6(5):587–596CrossRef Moravsky G, Ofek E, Rakowski H, Butany J, Williams L, Ralph-Edwards A et al (2013) Myocardial fibrosis in hypertrophic cardiomyopathy: accurate reflection of histopathological findings by CMR. JACC Cardiovasc Imaging 6(5):587–596CrossRef
20.
Zurück zum Zitat Liu D, Ma X, Liu J, Zhao L, Chen H, Xu L et al (2017) Quantitative analysis of late gadolinium enhancement in hypertrophic cardiomyopathy: comparison of diagnostic performance in myocardial fibrosis between gadobutrol and gadopentetate dimeglumine. Int J Cardiovasc Imaging 33(8):1191–1200CrossRef Liu D, Ma X, Liu J, Zhao L, Chen H, Xu L et al (2017) Quantitative analysis of late gadolinium enhancement in hypertrophic cardiomyopathy: comparison of diagnostic performance in myocardial fibrosis between gadobutrol and gadopentetate dimeglumine. Int J Cardiovasc Imaging 33(8):1191–1200CrossRef
21.
Zurück zum Zitat Mikami Y, Kolman L, Joncas SX, Stirrat J, Scholl D, Rajchl M et al (2014) Accuracy and reproducibility of semi-automated late gadolinium enhancement quantification techniques in patients with hypertrophic cardiomyopathy. J Cardiovasc Magn Reson 16:85CrossRef Mikami Y, Kolman L, Joncas SX, Stirrat J, Scholl D, Rajchl M et al (2014) Accuracy and reproducibility of semi-automated late gadolinium enhancement quantification techniques in patients with hypertrophic cardiomyopathy. J Cardiovasc Magn Reson 16:85CrossRef
22.
Zurück zum Zitat Chung H, Yoon JH, Yoon YW, Park CH, Ko EJ, Kim JY et al (2014) Different contribution of extent of myocardial injury to left ventricular systolic and diastolic function in early reperfused acute myocardial infarction. Cardiovasc Ultrasound 12(6):1476–7120 Chung H, Yoon JH, Yoon YW, Park CH, Ko EJ, Kim JY et al (2014) Different contribution of extent of myocardial injury to left ventricular systolic and diastolic function in early reperfused acute myocardial infarction. Cardiovasc Ultrasound 12(6):1476–7120
23.
Zurück zum Zitat Moon JC, Messroghli DR, Kellman P, Piechnik SK, Robson MD, Ugander M et al (2013) Myocardial T1 mapping and extracellular volume quantification: a Society for Cardiovascular Magnetic Resonance (SCMR) and CMR Working Group of the European Society of Cardiology consensus statement. J Cardiovasc Magn Reson 15(1):92CrossRef Moon JC, Messroghli DR, Kellman P, Piechnik SK, Robson MD, Ugander M et al (2013) Myocardial T1 mapping and extracellular volume quantification: a Society for Cardiovascular Magnetic Resonance (SCMR) and CMR Working Group of the European Society of Cardiology consensus statement. J Cardiovasc Magn Reson 15(1):92CrossRef
24.
Zurück zum Zitat Yang HS, Song JK, Song JM, Kang DH, Lee CW, Hong MK et al (2005) Comparison of the clinical features of apical hypertrophic cardiomyopathy versus asymmetric septal hypertrophy in Korea. Korean J Intern Med 20(2):111–115CrossRef Yang HS, Song JK, Song JM, Kang DH, Lee CW, Hong MK et al (2005) Comparison of the clinical features of apical hypertrophic cardiomyopathy versus asymmetric septal hypertrophy in Korea. Korean J Intern Med 20(2):111–115CrossRef
25.
Zurück zum Zitat Aydin AA, Ulutas KT, Aydin C, Kaya M, Akar U, Ture T (2016) Successful evaluation of biphasic T-wave of wellens syndrome in the emergency department. Acta Inform Med 24(1):72–73CrossRef Aydin AA, Ulutas KT, Aydin C, Kaya M, Akar U, Ture T (2016) Successful evaluation of biphasic T-wave of wellens syndrome in the emergency department. Acta Inform Med 24(1):72–73CrossRef
26.
Zurück zum Zitat de Zwaan C, Bar FW, Wellens HJ (1982) Characteristic electrocardiographic pattern indicating a critical stenosis high in left anterior descending coronary artery in patients admitted because of impending myocardial infarction. Am Heart J 103(4 Pt 2):730–736CrossRef de Zwaan C, Bar FW, Wellens HJ (1982) Characteristic electrocardiographic pattern indicating a critical stenosis high in left anterior descending coronary artery in patients admitted because of impending myocardial infarction. Am Heart J 103(4 Pt 2):730–736CrossRef
27.
Zurück zum Zitat Prenner SB, Shah SJ, Goldberger JJ, Sauer AJ (2016) Repolarization heterogeneity: beyond the QT interval. J Am Heart Assoc 5(5):e003607CrossRef Prenner SB, Shah SJ, Goldberger JJ, Sauer AJ (2016) Repolarization heterogeneity: beyond the QT interval. J Am Heart Assoc 5(5):e003607CrossRef
28.
Zurück zum Zitat Konno T, Hayashi K, Fujino N, Oka R, Nomura A, Nagata Y et al (2015) Electrocardiographic QRS fragmentation as a marker for myocardial fibrosis in hypertrophic cardiomyopathy. J Cardiovasc Electrophysiol 26(10):1081–1087CrossRef Konno T, Hayashi K, Fujino N, Oka R, Nomura A, Nagata Y et al (2015) Electrocardiographic QRS fragmentation as a marker for myocardial fibrosis in hypertrophic cardiomyopathy. J Cardiovasc Electrophysiol 26(10):1081–1087CrossRef
Metadaten
Titel
Electrocardiography based prediction of hypertrophy pattern and fibrosis amount in hypertrophic cardiomyopathy: comparative study with cardiac magnetic resonance imaging
verfasst von
Chul Hwan Park
Hyemoon Chung
Yoonjung Kim
Jong-Youn Kim
Pil-Ki Min
Kyung-A. Lee
Young Won Yoon
Tae Hoon Kim
Byoung Kwon Lee
Bum-Kee Hong
Se-Joong Rim
Hyuck Moon Kwon
Eui-Young Choi
Publikationsdatum
04.05.2018
Verlag
Springer Netherlands
Erschienen in
The International Journal of Cardiovascular Imaging / Ausgabe 10/2018
Print ISSN: 1569-5794
Elektronische ISSN: 1875-8312
DOI
https://doi.org/10.1007/s10554-018-1365-6

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