Electrocardiography based prediction of hypertrophy pattern and fibrosis amount in hypertrophic cardiomyopathy: comparative study with cardiac magnetic resonance imaging

Chul Hwan Park, Hyemoon Chung, Yoonjung Kim, Jong Youn Kim, Pil Ki Min, Kyunga Lee, Young Won Yoon, Tae Hoon Kim, Byoung Kwon Lee, Bum Kee Hong, Se Joong Rim, Hyuck Moon Kwon, Eui Young Choi

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1 Citation (Scopus)

Abstract

Although, cardiac magnetic resonance imaging (CMR) is a gold standard for risk stratification of hypertrophic cardiomyopathy (HCM), is limited in some situations. We sought to evaluate the predictive power of quantitative electrocardiography in assessing hypertrophy pattern and fibrosis in HCM. Eighty-eight patients with HCM were studied. Voltage of R–S–T waves, number of fragmented QRS (fQRS) complexes, and T wave morphology were measured by 12-lead electrocardiography. Sixteen segmental thickness, late gadolinium enhancement (LGE), native T1, extracellular volume fraction (ECV), and T2, left ventricular (LV) mass and %LGE were measured by CMR. Patterns of LV hypertrophy were classified as pure apical, mixed, or asymmetrical septal hypertrophy. Positive and negative predictive values of biphasic T wave for pure apical type were 70.4 and 63.9%, and the predictive values of precordial negative T wave sums > 12.5 mm were 69.2 and 79.6%. Precordial S waves, especially Cornell voltage index, were significantly correlated to LV mass index and maximal thickness (p <0.001). The number of fQRS leads was significantly correlated to %LGE, average ECV, and T2 (all p <0.001). More than one lead with fQRS could predict >5% of LGE mass with 58% sensitivity and 63% specificity (p = 0.049, area under the curve = 0.627). However, degree of correlation between maximal thickness and precordial S was poor in cases with fQRS more two leads. T wave morphology and precordial S helps discriminate hypertrophy pattern and maximal hypertrophy, however, in cases with more than two leads of concomitant fQRS, CMR defines fibrosis amount and hypertrophy more accurately.

Original languageEnglish
Pages (from-to)1619-1628
Number of pages10
JournalInternational Journal of Cardiovascular Imaging
Volume34
Issue number10
DOIs
Publication statusPublished - 2018 Oct 1

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Hypertrophic Cardiomyopathy
Hypertrophy
Electrocardiography
Fibrosis
Magnetic Resonance Imaging
Gadolinium
Left Ventricular Hypertrophy
Area Under Curve
Sensitivity and Specificity

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Park, Chul Hwan ; Chung, Hyemoon ; Kim, Yoonjung ; Kim, Jong Youn ; Min, Pil Ki ; Lee, Kyunga ; Yoon, Young Won ; Kim, Tae Hoon ; Lee, Byoung Kwon ; Hong, Bum Kee ; Rim, Se Joong ; Kwon, Hyuck Moon ; Choi, Eui Young. / Electrocardiography based prediction of hypertrophy pattern and fibrosis amount in hypertrophic cardiomyopathy : comparative study with cardiac magnetic resonance imaging. In: International Journal of Cardiovascular Imaging. 2018 ; Vol. 34, No. 10. pp. 1619-1628.
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title = "Electrocardiography based prediction of hypertrophy pattern and fibrosis amount in hypertrophic cardiomyopathy: comparative study with cardiac magnetic resonance imaging",
abstract = "Although, cardiac magnetic resonance imaging (CMR) is a gold standard for risk stratification of hypertrophic cardiomyopathy (HCM), is limited in some situations. We sought to evaluate the predictive power of quantitative electrocardiography in assessing hypertrophy pattern and fibrosis in HCM. Eighty-eight patients with HCM were studied. Voltage of R–S–T waves, number of fragmented QRS (fQRS) complexes, and T wave morphology were measured by 12-lead electrocardiography. Sixteen segmental thickness, late gadolinium enhancement (LGE), native T1, extracellular volume fraction (ECV), and T2, left ventricular (LV) mass and {\%}LGE were measured by CMR. Patterns of LV hypertrophy were classified as pure apical, mixed, or asymmetrical septal hypertrophy. Positive and negative predictive values of biphasic T wave for pure apical type were 70.4 and 63.9{\%}, and the predictive values of precordial negative T wave sums > 12.5 mm were 69.2 and 79.6{\%}. Precordial S waves, especially Cornell voltage index, were significantly correlated to LV mass index and maximal thickness (p <0.001). The number of fQRS leads was significantly correlated to {\%}LGE, average ECV, and T2 (all p <0.001). More than one lead with fQRS could predict >5{\%} of LGE mass with 58{\%} sensitivity and 63{\%} specificity (p = 0.049, area under the curve = 0.627). However, degree of correlation between maximal thickness and precordial S was poor in cases with fQRS more two leads. T wave morphology and precordial S helps discriminate hypertrophy pattern and maximal hypertrophy, however, in cases with more than two leads of concomitant fQRS, CMR defines fibrosis amount and hypertrophy more accurately.",
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Electrocardiography based prediction of hypertrophy pattern and fibrosis amount in hypertrophic cardiomyopathy : comparative study with cardiac magnetic resonance imaging. / Park, Chul Hwan; Chung, Hyemoon; Kim, Yoonjung; Kim, Jong Youn; Min, Pil Ki; Lee, Kyunga; Yoon, Young Won; Kim, Tae Hoon; Lee, Byoung Kwon; Hong, Bum Kee; Rim, Se Joong; Kwon, Hyuck Moon; Choi, Eui Young.

In: International Journal of Cardiovascular Imaging, Vol. 34, No. 10, 01.10.2018, p. 1619-1628.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Electrocardiography based prediction of hypertrophy pattern and fibrosis amount in hypertrophic cardiomyopathy

T2 - comparative study with cardiac magnetic resonance imaging

AU - Park, Chul Hwan

AU - Chung, Hyemoon

AU - Kim, Yoonjung

AU - Kim, Jong Youn

AU - Min, Pil Ki

AU - Lee, Kyunga

AU - Yoon, Young Won

AU - Kim, Tae Hoon

AU - Lee, Byoung Kwon

AU - Hong, Bum Kee

AU - Rim, Se Joong

AU - Kwon, Hyuck Moon

AU - Choi, Eui Young

PY - 2018/10/1

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N2 - Although, cardiac magnetic resonance imaging (CMR) is a gold standard for risk stratification of hypertrophic cardiomyopathy (HCM), is limited in some situations. We sought to evaluate the predictive power of quantitative electrocardiography in assessing hypertrophy pattern and fibrosis in HCM. Eighty-eight patients with HCM were studied. Voltage of R–S–T waves, number of fragmented QRS (fQRS) complexes, and T wave morphology were measured by 12-lead electrocardiography. Sixteen segmental thickness, late gadolinium enhancement (LGE), native T1, extracellular volume fraction (ECV), and T2, left ventricular (LV) mass and %LGE were measured by CMR. Patterns of LV hypertrophy were classified as pure apical, mixed, or asymmetrical septal hypertrophy. Positive and negative predictive values of biphasic T wave for pure apical type were 70.4 and 63.9%, and the predictive values of precordial negative T wave sums > 12.5 mm were 69.2 and 79.6%. Precordial S waves, especially Cornell voltage index, were significantly correlated to LV mass index and maximal thickness (p <0.001). The number of fQRS leads was significantly correlated to %LGE, average ECV, and T2 (all p <0.001). More than one lead with fQRS could predict >5% of LGE mass with 58% sensitivity and 63% specificity (p = 0.049, area under the curve = 0.627). However, degree of correlation between maximal thickness and precordial S was poor in cases with fQRS more two leads. T wave morphology and precordial S helps discriminate hypertrophy pattern and maximal hypertrophy, however, in cases with more than two leads of concomitant fQRS, CMR defines fibrosis amount and hypertrophy more accurately.

AB - Although, cardiac magnetic resonance imaging (CMR) is a gold standard for risk stratification of hypertrophic cardiomyopathy (HCM), is limited in some situations. We sought to evaluate the predictive power of quantitative electrocardiography in assessing hypertrophy pattern and fibrosis in HCM. Eighty-eight patients with HCM were studied. Voltage of R–S–T waves, number of fragmented QRS (fQRS) complexes, and T wave morphology were measured by 12-lead electrocardiography. Sixteen segmental thickness, late gadolinium enhancement (LGE), native T1, extracellular volume fraction (ECV), and T2, left ventricular (LV) mass and %LGE were measured by CMR. Patterns of LV hypertrophy were classified as pure apical, mixed, or asymmetrical septal hypertrophy. Positive and negative predictive values of biphasic T wave for pure apical type were 70.4 and 63.9%, and the predictive values of precordial negative T wave sums > 12.5 mm were 69.2 and 79.6%. Precordial S waves, especially Cornell voltage index, were significantly correlated to LV mass index and maximal thickness (p <0.001). The number of fQRS leads was significantly correlated to %LGE, average ECV, and T2 (all p <0.001). More than one lead with fQRS could predict >5% of LGE mass with 58% sensitivity and 63% specificity (p = 0.049, area under the curve = 0.627). However, degree of correlation between maximal thickness and precordial S was poor in cases with fQRS more two leads. T wave morphology and precordial S helps discriminate hypertrophy pattern and maximal hypertrophy, however, in cases with more than two leads of concomitant fQRS, CMR defines fibrosis amount and hypertrophy more accurately.

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