Yonsei Med J.  2015 Nov;56(6):1515-1521. 10.3349/ymj.2015.56.6.1515.

Morphological and Electrical Characteristics in Patient with Hypertrophic Cardiomyopathy: Quantitative Analysis of 864 Korean Cohort

• Kim SH
• Oh YS
• Nam GB
• Choi KJ
• Kim DH
• Song JM
• Kang DH
• Song JK
• Kim YH

• KMID: 2345877
• DOI: http://doi.org/10.3349/ymj.2015.56.6.1515

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 Korean tertiary 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 asymmetric HCM, 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 frequent in 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.

Keyword

Hypertrophic cardiomyopathy; electrocardiography; echocardiography

MeSH Terms

Adult
Aged
Cardiomyopathy, Hypertrophic/diagnosis
Echocardiography/*methods
Electrocardiography/*methods
Female
Heart Rate/*physiology
Humans
Male
Middle Aged
Republic of Korea/epidemiology

Figure

• 

  Fig. 1 Proportion of hypertrophic cardiomyopathy type relative to patient's age. In contrast to asymmetric hypertrophy, the proportion of patients with apical hypertrophy increased with age.

• 

  Fig. 2 Electrocardiographic abnormalities according to the type of hypertrophy. *Advanced electrical abnormalities such as QT prolongation, QRS widening, PR prolongation, and pathologic Q wave were more prevalent in patients with asymmetric hypertrophy. LV, left ventricle; QTc, corrected QT duration ≥480 msec; QRS, QRS duration ≥120 msec; PR, PR interval ≥200 msec; Q wave, pathologic Q wave; anterior J, J point in anterior leads ≥0.1 mV; inferior J, J point in inferior leads ≥0.1 mV; lateral J, J point in lateral leads ≥0.1 mV; AF, atrial fibrillation.

• 

  Fig. 3 The amplitude T wave inversion according to the type of hypertrophic cardiomyopathy. HCM, hypertrophic cardiomyopathy.

• 

  Fig. 4 Correlation between apical wall thickness and the amplitude of T wave inversion in patients with apical hypertrophy. No significant correlation was observed.

Reference

1. Abbasi AS, MacAlpin RN, Eber LM, Pearce ML. Echocardiographic diagnosis of idiopathic hypertrophic cardiomyopathy without outflow obstruction. Circulation. 1972; 46:897–904.

2. Henry WL, Clark CE, Epstein SE. Asymmetric septal hypertrophy. Echocardiographic identification of the pathognomonic anatomic abnormality of IHSS. Circulation. 1973; 47:225–233.

3. Pridie RB, Oakley C. Mitral valve movement in hypertrophic obstructive cardiomyopathy. Br Heart J. 1969; 31:390.

4. Sakamoto T, Tei C, Murayama M, Ichiyasu H, Hada Y. Giant T wave inversion as a manifestation of asymmetrical apical hypertrophy (AAH) of the left ventricle. Echocardiographic and ultrasono-cardiotomographic study. Jpn Heart J. 1976; 17:611–629.

5. Klues HG, Schiffers A, Maron BJ. 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. 1995; 26:1699–1708.

6. Maron BJ, Wolfson JK, Ciró E, Spirito P. Relation of electrocardiographic abnormalities and patterns of left ventricular hypertrophy identified by 2-dimensional echocardiography in patients with hypertrophic cardiomyopathy. Am J Cardiol. 1983; 51:189–194.

7. Savage DD, Seides SF, Clark CE, Henry WL, Maron BJ, Robinson FC, et al. Electrocardiographic findings in patients with obstructive and nonobstructive hypertrophic cardiomyopathy. Circulation. 1978; 58(3 Pt 1):402–408.

8. Prescott R, Quinn JS, Littmann D. Electrocardiographic changes in hypertrophic subaortic stenosis which simulate myocardial infarction. Am Heart J. 1963; 66:42–48.

9. Cosio FG, Moro C, Alonso M, de la Calzada CS, Liovet A. The Q waves hypertrophic cardiomyopathy: an electrophysiologic study. N Engl J Med. 1980; 302:96–99.

10. Maron BJ, Maron MS, Wigle ED, Braunwald E. 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. 2009; 54:191–200.

11. Maron BJ, McKenna WJ, Danielson GK, Kappenberger LJ, Kuhn HJ, Seidman CE, et al. 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. J Am Coll Cardiol. 2003; 42:1687–1713.

12. Yamaguchi H, Ishimura T, Nishiyama S, Nagasaki F, Nakanishi S, Takatsu F, et al. Hypertrophic nonobstructive cardiomyopathy with giant negative T waves (apical hypertrophy): ventriculographic and echocardiographic features in 30 patients. Am J Cardiol. 1979; 44:401–412.

13. Chikamori T, Doi YL, Akizawa M, Yonezawa Y, Ozawa T, McKenna WJ. Comparison of clinical, morphological, and prognostic features in hypertrophic cardiomyopathy between Japanese and western patients. Clin Cardiol. 1992; 15:833–837.

14. Kim SH, Kim SO, Han S, Hwang KW, Lee CW, Nam GB, et al. Long-term comparison of apical versus asymmetric hypertrophic cardiomyopathy. Int Heart J. 2013; 54:207–211.

15. Eriksson MJ, Sonnenberg B, Woo A, Rakowski P, Parker TG, Wigle ED, et al. Long-term outcome in patients with apical hypertrophic cardiomyopathy. J Am Coll Cardiol. 2002; 39:638–645.

16. Otto CM. The practice of clinical echocardiography. 2nd ed. Philadelphia: W.B. Saunders;2002. p. 589.

17. Feigenbaum H, Armstrong WF, Ryan T. Feigenbaum's echocardiography. 6th ed. Philadelphia: Lippincott Williams & Wilkins;2005. p. 545.

18. Romhilt DW, Bove KE, Norris RJ, Conyers E, Conradi S, Rowlands DT, et al. A critical appraisal of the electrocardiographic criteria for the diagnosis of left ventricular hypertrophy. Circulation. 1969; 40:185–195.

19. Wagner GS, Marriott HJL. Marriott's practical electrocardiography. 10th ed. Philadelphia: Lippincott Williams & Wilkins;2001. p. 90–93.

20. Maron BJ, Gardin JM, Flack JM, Gidding SS, Kurosaki TT, Bild DE. 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. 1995; 92:785–789.

21. Brock R. Functional obstruction of the left ventricle; acquired aortic subvalvar stenosis. Guys Hosp Rep. 1957; 106:221–238.

22. Teare D. Asymmetrical hypertrophy of the heart in young adults. Br Heart J. 1958; 20:1–8.

23. Braunwald E, Lambrew CT, Rockoff SD, Ross J Jr, Morrow AG. Idiopathic hypertrophic subaortic stenosis. I. A description of the disease based upon an analysis of 64 patients. Circulation. 1964; 30:Suppl 4. 3–119.

24. Maron BJ, Bonow RO, Cannon RO 3rd, Leon MB, Epstein SE. Hypertrophic cardiomyopathy. Interrelations of clinical manifestations, pathophysiology, and therapy (2). N Engl J Med. 1987; 316:844–852.

25. Maron BJ. Hypertrophic cardiomyopathy: a systematic review. JAMA. 2002; 287:1308–1320.

26. Louie EK, Maron BJ. Apical hypertrophic cardiomyopathy: clinical and two-dimensional echocardiographic assessment. Ann Intern Med. 1987; 106:663–670.

27. Ho CY, Sweitzer NK, McDonough B, Maron BJ, Casey SA, Seidman JG, et al. Assessment of diastolic function with Doppler tissue imaging to predict genotype in preclinical hypertrophic cardiomyopathy. Circulation. 2002; 105:2992–2997.

28. Maron BJ, Spirito P, Green KJ, Wesley YE, Bonow RO, Arce J. Noninvasive assessment of left ventricular diastolic function by pulsed Doppler echocardiography in patients with hypertrophic cardiomyopathy. J Am Coll Cardiol. 1987; 10:733–742.

29. Maron BJ, Spirito P. Implications of left ventricular remodeling in hypertrophic cardiomyopathy. Am J Cardiol. 1998; 81:1339–1344.

30. Spirito P, Maron BJ, Bonow RO, Epstein SE. Occurrence and significance of progressive left ventricular wall thinning and relative cavity dilatation in hypertrophic cardiomyopathy. Am J Cardiol. 1987; 60:123–129.

31. Hina K, Kusachi S, Iwasaki K, Nogami K, Moritani H, Kita T, et al. Progression of left ventricular enlargement in patients with hypertrophic cardiomyopathy: incidence and prognostic value. Clin Cardiol. 1993; 16:403–407.

32. Tsunakawa H, Wei D, Mashima S, Harumi K. Study on the genesis of giant negative T wave in apical hypertrophic cardiomyopathy using a three-dimensional computer model. Jpn Heart J. 1991; 32:799–809.

33. Rowin EJ, Maron BJ, Appelbaum E, Link MS, Gibson CM, Lesser JR, et al. Significance of false negative electrocardiograms in preparticipation screening of athletes for hypertrophic cardiomyopathy. Am J Cardiol. 2012; 110:1027–1032.

34. Lakdawala NK, Thune JJ, Maron BJ, Cirino AL, Havndrup O, Bundgaard H, et al. Electrocardiographic features of sarcomere mutation carriers with and without clinically overt hypertrophic cardiomyopathy. Am J Cardiol. 2011; 108:1606–1613.

35. Park SY, Park TH, Kim JH, Baek HK, Seo JM, Kim WJ, et al. Relationship between giant negative T-wave and severity of apical hypertrophy in patients with apical hypertrophic cardiomyopathy. Echocardiography. 2010; 27:770–776.

36. Tikkanen JT, Anttonen O, Junttila MJ, Aro AL, Kerola T, Rissanen HA, et al. Long-term outcome associated with early repolarization on electrocardiography. N Engl J Med. 2009; 361:2529–2537.

37. Jeong JH. Prevalence of and risk factors for atrial fibrillation in Korean adults older than 40 years. J Korean Med Sci. 2005; 20:26–30.

38. Iguchi Y, Kimura K, Aoki J, Kobayashi K, Terasawa Y, Sakai K, et al. 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. 2008; 72:909–913.

39. Lok NS, Lau CP. Prevalence of palpitations, cardiac arrhythmias and their associated risk factors in ambulant elderly. Int J Cardiol. 1996; 54:231–236.

40. Go AS, Hylek EM, Phillips KA, Chang Y, Henault LE, Selby JV, et al. 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. 2001; 285:2370–2375.

41. Olivotto I, Cecchi F, Casey SA, Dolara A, Traverse JH, Maron BJ. Impact of atrial fibrillation on the clinical course of hypertrophic cardiomyopathy. Circulation. 2001; 104:2517–2524.