QRS prolongation is associated with associated with adverse cardiac remodeling in hypertrophic cardiomyopathy.

Autor: Vera-Sarmiento HL; Hypertrophic Cardiomyopathy Center of Excellence, Division of Cardiology, University of California San Francisco, San Francisco, CA, United States of America., Tanriverdi T; Hypertrophic Cardiomyopathy Center of Excellence, Division of Cardiology, University of California San Francisco, San Francisco, CA, United States of America; Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, United States of America., Hurtado-de-Mendoza D; Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America., Sivalokanathan S; Hypertrophic Cardiomyopathy Center of Excellence, Division of Cardiology, University of California San Francisco, San Francisco, CA, United States of America; Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America., Damera RR; Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America., Ketty D; Cayetano Heredia University, Peru., Lu D; Hypertrophic Cardiomyopathy Center of Excellence, Division of Cardiology, University of California San Francisco, San Francisco, CA, United States of America; Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America., Zimmerman S; Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America., Sinha S; Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America., Scheinman M; Division of Cardiology, University of California San Francisco, San Francisco, CA, United States of America., Abraham MR; Hypertrophic Cardiomyopathy Center of Excellence, Division of Cardiology, University of California San Francisco, San Francisco, CA, United States of America. Electronic address: Roselle.abraham@ucsf.edu.
Jazyk: angličtina
Zdroj: Journal of electrocardiology [J Electrocardiol] 2024 Nov-Dec; Vol. 87, pp. 153818. Date of Electronic Publication: 2024 Oct 22.
DOI: 10.1016/j.jelectrocard.2024.153818
Abstrakt: Background: Signal-averaged electrocardiogram (SAECG) records myocardial depolarization, and can detect inhomogeneous/slow conduction in fibrotic myocardium, which promotes reentrant ventricular arrhythmias (VAs). Hypertrophic cardiomyopathy (HCM) is associated with a high prevalence of cardiac fibrosis and VAs, but abnormal SAECG has low predictive power for VAs. We hypothesized that HCM-specific structural/electrical remodeling underlies this result.
Methods: We tested our hypothesis by retrospectively studying HCM patients (n = 73) who underwent transthoracic echocardiography (TTE) and cardiac magnetic resonance (CMR) imaging within 12 months of SAECG and 12‑lead ECG. Patients were divided into 2 groups (normal-SAECG, abnormal-SAECG) based on filtered-QRS duration (fQRSd), root-mean-square-voltage (RMS40) and low-amplitude (<40 μV) signal of terminal 40 ms of filtered-QRS (late potentials). Abnormal SAECG was defined as fQRSd > 114 ms, RMS40 < 20 μV or LAS40 > 38 ms.
Results: Abnormal SAECG was seen in ∼50 % of HCM patients (37/73). In the abnormal-SAECG group, 78 % (n = 29) only had prolonged fQRSd, and 22 % (n = 8) had prolonged fQRSd plus late potentials (RMS40 < 20 μV or LAS40 > 38 ms). Mean fQRSd and LAS40 were significantly higher in the abnormal-SAECG group. The abnormal-SAECG group had significantly larger LA size, lower global-LV longitudinal systolic strain/strain rate and early-diastolic strain rate by TTE; higher LV-mass index (LVMI) and LV-scar burden by CMR; higher prevalence of repolarization abnormalities on 12‑lead ECG. LVEF and adverse outcomes (VT/VF, heart failure, death) were similar in the 2 groups. Univariate analysis showed that fQRSd is positively correlated with LVMI, LV-scar mass, and negatively correlated with global-LV early diastolic strain rate.
Conclusions: In HCM, abnormal SAECG is associated with greater structural/electrical LV-remodeling, reflecting a severe global myopathy.
Competing Interests: Declaration of competing interest The Authors do not declare any conflicts of interest.
(Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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