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Volume 110, Nº 1, January 2018


DOI: http://www.dx.doi.org/10.5935/abc.20170189


Correlation of Electrocardiographic Changes with Cardiac Magnetic Resonance Findings in Patients with Hypertrophic Cardiomyopathy

Gabriela Miana de Mattos Paixão

Horácio Eduardo Veronesi

Halsted Alarcão Gomes Pereira da Silva

José Nunes de Alencar Neto

Carolina de Paulo Maldi

Luciano de Figueiredo Aguiar Filho

Ibrahim Masciarelli Francisco Pinto

Francisco Faustino de Albuquerque Carneiro de França

Edileide de Barros Correia

Figure 1 – Segmentação ventricular esquerda proposta pela American Heart Association


Background: Electrocardiogram is the initial test in the investigation of heart disease. Electrocardiographic changes in hypertrophic cardiomyopathy have no set pattern, and correlates poorly with echocardiographic findings. Cardiac magnetic resonance imaging has been gaining momentum for better assessment of hypertrophy, as well as the detection of myocardial fibrosis.

Objectives: To correlate the electrocardiographic changes with the location of hypertrophy in hypertrophic cardiomyopathy by cardiac magnetic resonance.

Methods: This descriptive cross-sectional study evaluated 68 patients with confirmed diagnosis of hypertrophic cardiomyopathy by cardiac magnetic resonance. The patients’ electrocardiogram was compared with the location of the greatest myocardial hypertrophy by cardiac magnetic resonance. Statistical significance level of 5% and 95% confidence interval were adopted.

Results: Of 68 patients, 69% had septal hypertrophy, 21% concentric and 10% apical hypertrophies. Concentric hypertrophy showed the greatest myocardial fibrosis mass (p < 0.001) and the greatest R wave size in D1 (p = 0.0280). The amplitudes of R waves in V5 and V6 (p = 0.0391, p = 0.0148) were higher in apical hypertrophy, with statistical significance. Apical hypertrophy was also associated with higher T wave negativity in D1, V5 and V6 (p < 0.001). Strain pattern was found in 100% of the patients with apical hypertrophy (p < 0.001).

Conclusion: The location of myocardial hypertrophy by cardiac magnetic resonance can be correlated with electrocardiographic changes, especially for apical hypertrophy. (Arq Bras Cardiol. 2018; 110(1):52-59)

Keywords: Hypertrophic cardiomyopathy / genetic; Electrocardiography; Magnetic Resonance Spectroscopy.