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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  ;  Kyung-A. Lee  ;  Young Won Yoon  ;  Tae Hoon Kim  ;  Byoung Kwon Lee  ;  Bum-Kee Hong  ;  Se-Joong Rim  ;  Hyuck Moon Kwon  ;  Eui-Young Choi 
 International Journal of Cardiovascular Imaging, Vol.34(10) : 1619-1628, 2018 
Journal Title
 International Journal of Cardiovascular Imaging 
Issue Date
Cardiac magnetic resonance imaging ; Electrocardiography ; Fibrosis ; Hypertrophic cardiomyopathy
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 [Formula: see text] 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 [Formula: see text]0.001). The number of fQRS leads was significantly correlated to %LGE, average ECV, and T2 (all p [Formula: see text]0.001). More than one lead with fQRS could predict [Formula: see text]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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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
권혁문(Kwon, Hyuck Moon) ORCID logo https://orcid.org/0000-0001-9901-5015
김윤정(Kim, Yoon Jung) ORCID logo https://orcid.org/0000-0002-4370-4265
김종윤(Kim, Jong Youn) ORCID logo https://orcid.org/0000-0001-7040-8771
김태훈(Kim, Tae Hoon) ORCID logo https://orcid.org/0000-0003-3598-2529
민필기(Min, Pil Ki) ORCID logo https://orcid.org/0000-0001-7033-7651
박철환(Park, Chul Hwan) ORCID logo https://orcid.org/0000-0002-0004-9475
윤영원(Yoon, Young Won) ORCID logo https://orcid.org/0000-0002-0907-0350
이병권(Lee, Byoung Kwon) ORCID logo https://orcid.org/0000-0001-9259-2776
임세중(Rim, Se Joong) ORCID logo https://orcid.org/0000-0002-7631-5581
최의영(Choi, Eui Young) ORCID logo https://orcid.org/0000-0003-3732-0190
홍범기(Hong, Bum Kee) ORCID logo https://orcid.org/0000-0002-6456-0184
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