Relationship of ECG findings to phenotypic expression in patients with hypertrophic cardiomyopathy: A cardiac magnetic resonance study
Relationship of ECG findings to phenotypic expression in patients with hypertrophic cardiomyopathy: A cardiac magnetic resonance study
复制标题
DOI：
10.1016/j.ijcard.2012.03.074
复制
发表时间：
2013-08-10
影响因子：
3.5
通讯作者：
Gaita, Fiorenzo
中科院分区：
文献类型：
--
作者：
Delcre, Sara Dalila Luisella;Di Donna, Paolo;Gaita, Fiorenzo
背景：12导联心电图（ECG）被认为是肥厚型心肌病（HCM）的重要筛查工具。HCM中描述了大量的ECG异常，尽管它们与左心室（LV）形态和肥大程度的关系似乎难以捉摸。本研究的目的是评估心电图模式与HCM表型的关系，根据心脏磁成像（CMR）提供的新机会进行评估。方法：257例HCM患者进行CMR和12导联心电图。ECG异常的严重程度由9个标准的总和定义：异常心律、QRS持续时间>= 100 ms、Romhilt-Estes评分>= 5、分支阻滞（LAHB）和/或分支阻滞（LBBB或RBBB）、ST-T异常、ST-T段抬高>= 0.2 mV、QTc间期延长、病理性Q波、无正常Q波。结果：HCM患者心电图异常的严重程度与HCM表型有直接关系。大多数ECG正常患者的LV质量指数正常，并且随着ECG评分的每一级而逐渐增加，从ECG正常患者的70.9 ± 18.6 g/m2增加到ECG明显异常患者的107.1 ± 55.1 g/m2（男性p = 91 g/m2，女性>69 g/m2），最大左室厚度>= 30 mm时100%。结论：在一个大型HCM队列中，ECG异常的数量和严重程度与CMR所显示的表型表达直接相关。虽然假阴性ECG结果在HCM人群筛查中仍然是一个挑战，但正常ECG被证明可以有效排除严重LV肥大，这表明对HCM患者及其家庭成员的长期随访具有潜在意义。一个简单的评分HCM患者的心电图异常的量化建议。(C)2012爱思唯尔爱尔兰有限公司保留所有权利。
Background: The 12-lead electrocardiogram (ECG) is considered an essential screening tool for hypertrophic cardiomyopathy (HCM). A vast array of ECG abnormalities has been described in HCM, although their relationship to left ventricle (LV) morphology and degree of hypertrophy appears elusive. Aim of this study was to assess the relationship of ECG patterns with the HCM phenotype assessed according to the novel opportunities offered by cardiac magnetic imaging (CMR).Methods: CMR and 12-lead ECG were performed in 257 HCM patients. Severity of ECG abnormalities was defined by the sum of 9 criteria: abnormal cardiac rhythm, QRS duration >= 100 ms, Romhilt-Estes score >= 5, fascicular block (LAHB) and/or bundle-branch block (LBBB or RBBB), ST-T abnormalities, ST-T segment elevation >= 0.2 mV, prolonged QTc interval, pathological Q waves, absence of normal Q wave. Four ECG groups were identified: normal (0 criteria); mildly abnormal (1-3 criteria); moderately abnormal (4-6 criteria); markedly abnormal (7-9 criteria).Results: There was a direct relationship between severity of ECG abnormalities and HCM phenotype. LV mass index was normal in most patients with normal ECG and progressively increased with each class of ECG score, from 70.9 +/- 18.6 g/m(2) in patients with normal ECG to 107.1 +/- 55.1 g/m(2) among those with markedly abnormal ECG (p = 91 g/m(2) for men and >69 g/m(2) for women), and of 100% for maximum LV thickness >= 30 mm.Conclusions: In a large HCM cohort, the number and severity of ECG abnormalities were directly related to phenotypic expression as revealed by CMR. Although false negative ECG findings remain a challenge in population screenings for HCM, a normal ECG proved effective in ruling out severe LV hypertrophy, suggesting potential implications for long-term follow-up of HCM patients and family members. A simple score for quantification of ECG abnormalities in HCM patients is proposed. (C) 2012 Elsevier Ireland Ltd. All rights reserved.