Investigation On The Patterns Of Left Ventricular Apical Hypertrophy And Voltage Of Negative T Wave

Objectives Apical hypertrophic cardiomyopathy(AHCM)is a phenotypic variant of hypertrophic cardiomyopathy(HCM)which hypertrophy is predominantly in the left ventricular apex with different morphologic subtypes.AHCM usually has negative T wave in precordial leads.This study was to analyze the relationship between hypertrophic patterns and the voltage of negative T wave.Methods 102 consecutive patients(85 males,range 23-85 years)from August 2015 to November 2018 with T-wave inversion and left ventricular apical hypertrophy or thickened apex were enrolled into this study.Patients were classified into four groups as 53 typiacl AHCM(T-AHCM),25 pre-AHCM(P-AHCM),13 suspected pre-AHCM(SP-AHCM)and 11 AHCM with predominant thickening in the midventricular distribution(M-AHCM).ECG and other clinical data were collected.Voltage of negative T wave,maximal voltage of negative T wave in 12 leads(Tmax),sum of voltage of negative T waves in precordial leads(sum of NT),and maximal voltage amplitude of R wave(Rmax)were measured.Conventional echocardiographic parameters were acquired,including left ventricular diameter,wall thickness,left ventricular ejection fraction(LVEF),left atrial volume(LAV),transmitral diastolic inflow velocities(E,A),mitral annular lateral and septum velocities in early diastole(e1,e2);Apical morphology measurements included thickness of septum,anterior wall,lateral wall and posterior wall in apical,maximal apical wall thickness(APWTmax),mean of apical wall thickness(APWTmean)and apical to basal posterior wall thickness ratio(ABR).Results 1.No differences in the distribution of negative T wave,the occurrence of GNT,the maximum depth of T wave and the sum of depth of T wave in precordial leads were found among the four groups.2.No difference was found in the patterns of hypertrophy,the magnitude of apical hypertrophy,male and age between AHCM patients of GNT and without GNT 3.In 78 cases of P-AHCM and T-AHCM,no significant correlation was found between magnitude of apical hypertrophy and depth of T wave,however,correlations of APWTmax with TV5(r=0.38,P=0.041)and Tmax(r=0.42,P=0.025)was found only in 29 patients with pure AHCM,neither in mixed AHCM,nor in patients of SP-AHCM.Conclusions 2.The distribution of negative T wave is not correlated with the patterns of apical hypertrophy.1.The maximal apical wall thickness correlated with the voltage of negative T wave only occur in pure AHCM,not in mixed AHCM or other patterns of apical hypertrophy.