Value of convex-type ST-segment elevation and abnormal Q waves for electrocardiographic-based identification of left ventricular remodeling in hypertrophic cardiomyopathy.

Abstract

Several studies have demonstrated that the natural course of hypertrophic cardiomyopathy can be variable, often unpredictable with high morbidity and mortality. Therefore, screening for potential cases and periodical evaluation of affected patients is compelling. The purpose of our study is to assess a relationship of the electrocardiographic finding of ST-segment elevation and/or abnormal Q waves with the development of left ventricular enlargement and wall motion abnormalities in the echocardiography and to propose these findings as a sign of left ventricular remodeling in patients with hypertrophic cardiomyopathy. We enrolled 110 patients with hypertrophic cardiomyopathy. Standard echocardiography and 12-lead electrocardiograms were analyzed. After initial evaluation, follow up was conducted with a mean interval of 20.3 months. In the electrocardiograms we found ST-segment elevation in 43.6% and abnormal Q waves in 18.1%; and left ventricular enlargement in 12.7% and wall motion abnormalities in 21.8% in the echocardiograms. Three different patterns of ST-segment elevation were acknowledged: concave (13.6 %), straight (16.3 %) and convex (13.6%). There was a close relationship between the electrocardiographic finding of convex ST-segment elevation and/or abnormal Q waves and the occurrence of left ventricular enlargement and/or wall motion abnormalities in the echocardiograms with a sensitivity of 62% and a specificity of 85%. However, the straight and concave-type ST-segment elevation showed a less significant relationship with the echocardiographic findings. This study suggested that the electrocardiographic finding of convex ST-segment elevation and abnormal Q waves could be valuable for detection of disease progression in patients with hypertrophic cardiomyopathy.