Introduction:

in many cases, surface ECG suggests the diagnosis of hypertrophic cardiomyopathy (HCM) and is directly related to phenotypic expression. However, ECG changes have been not fully described in regional and local case series. Our study was aimed to characterize the ECG abnormalities in patients with HCM, correlating these findings with clinical and structural variables.

Method:

ECG recordings were interpreted in a cohort of 26 subjects with asymmetric septal HCM. All patients were studied by echocardiogram, adding MRI in 13 cases to evaluate the presence, extension and distribution of late gadolinium enhancement (LGE) as a marker of myocardial fibrosis. The correlation of ECG findings with symptoms, severity of hypertrophy and presence and extension of myocardial fibrosis was analyzed using Fisher’s exact test or non-parametric Mann-Whitney test.

Results:

the presence of a normal ECG was very infrequent in our sample (8,0%). The most common ECG abnormalities were observed in ventricular repolarization (76,9%) as systolic overload (42,3%) and T wave inversion (30,7%). ECG signs suggesting left atrium dilation (53,8%), left ventricle hypertrophy (LVH) criteria (61,5%), QRS fragmentation (46,2%) and abnormal Q waves (30,7%) were less frequently found. LVH was not correlated with symptoms, wall thickness, left ventricular outflow tract obstruction or presence of LGE. We found no significant relationship between LGE and fragmented QRS or abnormal Q waves. While patients with more severe septal hypertrophy exhibited large areas of LGE, this relationship did not reach statistical significance.

Conclusion:

in our cohort, the ECG is abnormal in 92,0% of patients with asymmetric septal HCM and is characterized by various alterations, confirming its usefulness as a screening tool. However, the findings in the ECG did not correlate closely with symptoms, amount of hypertrophy or presence of myocardial fibrosis. Larger local series must evaluate diagnostic contribution of combined ECG findings and its potential prognostic value in different phenotypic variants of HCM.

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