Predictors of late gadolinium enhancement in hypertrophic cardiomyopathy by electrocardiogram and echocardiography

Abstract

Objective To explore the predictive value of routine echocardiographic and electrocardiographic parameters in late gadolinium enhancement (LGE) in hypertrophic cardiomyopathy (HCM). Methods The study population consisted of a consecutive series of 95 HCM patients.According to the presence of LGE on cardiac magnetic resonance (CMR), these patients were divided into two groups: HCM patients with LGE (n=71) and HCM patients without LGE (n=24). The parameters of routine echocardiography and electrocardiography were compared between the two groups. ROC and Logistic analysis were made to find the predictors of LGE. Results ①As compared to those without LGE, HCM patients with LGE had higher prevalence of chest pain (P=0.027), β-blocker treatment (P=0.024), increased maximal left ventricular wall thickness (MLVWT) (P<0.000 1), non-sustained ventricular tachycardia (P=0.034), prolonged the rate-corrected cardiac QT interval (QTc) (P=0.011), T-wave inversion (TWI) (P=0.009), but reduced early diastolic mitral annular velocity (e′) (P=0.001). ②Univariate predictors of LGE on CMR were: increased MLVWT, reduced e′, prolonged QTc and more TWI. Only MLVWT (OR=1.23, 95%CI=1.05-1.44, P=0.013) and e′(OR=1.23, 95%CI=0.52-0.96, P=0.028) remained independent after multivariable analysis. Furthermore, the ROC analysis showed that these two parameters had discriminative ability to identify those with LGE. To be specific, HCM patients with MLVWT≥21.5 mm or e′≤5.55 cm/s were more likely to present with LGE. ③The leads number of TWI was positively correlated with percentage of LGE in left ventricular mass (LGE%) (r=0.220, P=0.044), but there was no correlation between location of TWI on ECG and territory of LGE on CMR. Conclusions In HCM patients, MLVWT and e′ are independent predictors of LGE on CMR. Furthermore, although the leads number of TWI is correlated with LGE%, no correlation has been found between location of TWI on ECG and territory of LGE on CMR. Key words: Echocardiography; Cardiomyopathy, hypertrophic; Electrocardiography; Late gadolinium enhancement