Is the 12-lead electrocardiogram of value in the prognostic assessment of patients with hypertrophic cardiomyopathy?
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BioMed Central
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Is the 12-lead electrocardiogram of value in the prognostic assessment of patients with hypertrophic cardiomyopathy? Ethan J Rowin*1, Evan Appelbaum2, Caitlin Harrigan1, Jacqueline L Buros3, Leah Biller3, C Michael R Gibson2, John R Lesser4, Tammy S Haas4, James E Udelson1, Warren J Manning2, Barry J Maron4 and Martin S Maron1 Address: 1Tufts Medical Center, Boston, MA, USA, 2Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA, 3PERFUSE Core Laboratory and Data Coordinating Center, Harvard Medical School, Boston, MA, USA and 4Minneapolis Heart Institute Foundation, Minneapolis, MN, USA * Corresponding author
from 13th Annual SCMR Scientific Sessions Phoenix, AZ, USA. 21-24 January 2010 Published: 21 January 2010 Journal of Cardiovascular Magnetic Resonance 2010, 12(Suppl 1):P197
doi:10.1186/1532-429X-12-S1-P197
Abstracts of the 13th Annual SCMR Scientific Sessions - 2010
Meeting abstracts - A single PDF containing all abstracts in this Supplement is available here. http://www.biomedcentral.com/content/files/pdf/1532-429X-11-S1-infoThis abstract is available from: http://jcmr-online.com/content/12/S1/P197 © 2010 Rowin et al; licensee BioMed Central Ltd.
Background Extreme magnitude of left ventricular hypertrophy (LVH) is an established risk factor for sudden death in hypertrophic cardiomyopathy (HCM), while myocardial scarring identified by contrast-enhanced cardiovascular magnetic resonance (CMR) may aid in risk stratification strategies. However, whether 12-lead ECG patterns are reliable for assessing magnitude of LVH or myocardial scarring by CMR in patients with HCM is unresolved. Therefore, we sought to determine the clinical utility of the ECG in a large HCM cohort with respect to these two clinical markers, using CMR, a high resolution 3-dimensional imaging technique.
Methods Cine and late gadolinium enhancement (LGE) CMR images and 12-lead ECG were obtained in 319 consecutive HCM patients (42 ± 17 years; 71% male). ECG parameters included total voltage score, voltage criteria (ie., Romholt-Estes, Sokolow-Lyon and Cornell score) and Q waves were compared to CMR findings of maximal LV wall thickness, LV mass index and the presence of LGE.
Results
dent between the commonly used ECG criteria for LVH and both LV wall thickness (R = 0.25, P < 0.001) and LV mass index (R = 0.29, P < 0.001). 3 of 20 patients (15%) with massive LVH (wall thickness >30 mm) and 47 of 211 (22%) with substantially increased LV mass index (>3SD) did not meet any of the ECG criteria for LVH. In addition, ECG criteria in patients with mild hypertrophy (wall thickness 15-19 mm) did not identify LVH in 52 of 122 patients (42%) (figure 1). There was a significant but weak correlation between total voltage score and both LV wall thickness (R = 0.25; P < 0.001) and mass index (R = 0.33; P < 0.001). Furthermore, no relationship was evident between the presence or extent of LGE and pathologic Q waves (p = 0.18 and 0.72, respectively); 13 of 23 patients (
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