| Objective Through the analysis of hypertrophic cardiomyopathy clinical information,imaging and ECG characteristics,This topic is to discuss the Obstructive hypertrophic cardiomyopathy and Non-obstructive hypertrophic cardiomyopathy and HCM difference between thick parts characteristics of clinical and ECG physiological characteristics,aims to enrich the relevant data of HCM,deepen the understanding of HCM and provide reference for the diagnosis and treatment of HCM.Methods1.General Hospital Heart Center,Ningxia Medical University were retrospectively analyzed internal medicine on January 1st,2011-December 31 st 2019 102 cases patients with HCM data.2.Grouping method2.1 According to the left ventricular outflow tract gradient(LVOTG)at rest,all patients were divided into OHCM(LVOTG ≥ 30 mm Hg)and NOHCM group(LVOTG<30mm Hg),aim to analyze clinical features,imaging data and treatment.2.2 According to the anatomical site of hypertrophy,the selected patients were divided into simple inventricular septal HCM group(group I),apical hypertrophic cardiomyopathy group(group Ⅱ),interventricular septum + apical HCM group(group Ⅲ),interventricular septum + left ventricular posterior wall HCM group(group Ⅳ),interventricular septum + left ventricular posterior wall + lateral wall HCM group(group V),diffuse HCM group(group Ⅵ),Other hypertrophy sites include right ventricular hypertrophy,inferior wall + lateral wall +posterior wall hypertrophy,interventricular septum + lateral wall hypertrophy,interventricular septum + anterior wall hypertrophy,and interventricular septum + anterior wall + lateral wall hypertrophy,which were studied separately due to the few cases.This group aims to further explore the electrocardiographic characteristics of HCM.3.Relevant indicators3.1 Clinical indicators: gender,age,blood pressure,heart rate,smoking history,drinking history,family genetic history of HCM,family history of SCD;Complications(such as hypertension,coronary heart disease,diabetes);Clinical symptoms(chest tightness,exertional dyspnea,chest pain,dizziness,amaurosis,palpitation,syncope)and typical murmurs and cardiac function grades(Grade I-Ⅳ).3.2 Imaging data: Imaging data: echocardiography(related parameters: left ventricular end-diastolic diameter,left ventricular end systolic diameter and ejection fraction,interventricular septum thickness,left ventricular posterior wall thickness,left atrium diameter,left ventricular outflow tract pressure difference,mitral valve systolic forward moving signs,degree of mitral regurgitation),cardiac magnetic resonance imaging and coronary angiography results.3.3 Electrophysiological indicators: the first routine ECG and 24-hour dynamic ECG were collected,includes all kinds of arrhythmias(atrial fibrillation,short atrial tachycardia,ventricular prephase contraction,non-persistent ventricular tachycardia,sinus bradycardia,atrioventricular block,bundle branch block),abnormal Q wave,abnormal ST segment,abnormal T wave,abnormal T wave,abnormal T wave,includes giant inverted Twaves(GNT).3.4 Treatment status: drug utilization rate,pacemaker implantation,percutaneous ventricular septal ablation,and left ventricular outflow tract dredging.Results1.Baseline data:A total of 102 HCM patients were enrolled,including 71 males(69.61%)and 31 females(30.39%).The ratio of male to female was 2.29: 1,and the average age of males was earlier than that of females(54.63 12.38 years VS 60.68 ±14.53 years,P<0.05).2.Grouping results:2.1 47 cases(46.08%)were divided into OHCM group and 55 cases(53.92%)were divided into NOHCM group.2.2 The selected cases were divided into group I(48.04%),group Ⅱ(13.73%),group Ⅲ(6.88%),group Ⅳ(8.84%),group V(8.84%),group Ⅵ(5.90%).There were 12 cases(11.76%)of other rare hypertrophy sites,including right ventricular hypertrophy in 3 cases,inferior wall+ lateral wall + posterior wall hypertrophy in 1 case,ventricular septum + lateral wall hypertrophy in 1 case,ventricular septum + anterior wall hypertrophy in 3 cases,and ventricular septum + anterior wall + lateral wall hypertrophy in 4 cases.3.OHCM group and NOHCM group3.1 Clinical features: compared with NOHCM,the OHCM group often suffered from laboring dyspnea(51.06% VS 30.91%,P<0.05),syncope(51.06% VS 30.91%,P<0.05)and typical murmur(95.74% VS 20.00%,P<0.05).The difference was statistically significant.3.2 Imaging indexes: compared with NOHCM group,the interventricular septum in OHCM group is thicker(19.26mm±4.09 mm VS 17.31mm±4.02 mm,P<0.05),SAM sign(29.79% VS 3.63%,P<0.05)and moderate and severe bicuspid regurgitation(23.40% VS9.09%)are more common.The difference was statistically significant.3.3 Treatment: There were no statistically significant differences in drug utilization rate,pacemaker implantation,ventricular septal alcohol ablation and left ventricular outflow tract dredging in the OHCM group(P>0.05).4.Arrhythmia and ECG abnormalities4.1 arrhythmology: 68 patients with HCM were complicated with different types of arrhythmia,accounting for 66.67%,20 patients with atrial fibrillation(19.61%),18 patients with short atrial tachycardia(17.65%),42 patients with ventricular premature beats(41.18%),13 patients with non-sustained ventricular tachycardia(12.75%)and 14 cases of sinus bradycardia(13.73%),13 cases of bundle branch block(12.75%)and 5 cases of atrioventricular block(4.90%).Compared with HCM without atrial fibrillation,the left atrial diameter of HCM with atrial fibrillation increased significantly(50.15mm±9.16 mm VS 40.23±6.15 mm,P<0.05),and the incidence of NYHA Ⅲ-Ⅳ grade was higher(50.00% VS 23.17%,P<0.05).4.2 ECG parameters: 22 cases(21.57%)of abnormal Q waves and 79 cases(77.45%)of abnormal ST-T were found,including 4 cases(3.92%)of ST segment elevation,75 cases(73.53%)of ST segment depression and 70 cases(68.63%)of T wave inversion,including 9cases(8.82%)of GNT.5.Electrophysiology of HCM in different hypertrophic sites5.1 Abnormal Q wave :Group Ⅰ(n=49): 13 cases(26.53%),4 cases(8.16%)appeared in the high lateral wall lead,6 cases(12.24%)in the lower wall lead,1 case(2.04%)in the anterior septal wall and 2 cases(4.08%)in the electrocardiogram.Group Ⅱ(n = 14): 1 case(7.14%)appeared in the inferior lead.Group Ⅲ(n=6): no abnormal q wave appeared.Group Ⅳ(n = 8): 2 cases(25.00%),all of which appeared in inferior lead.Group Ⅴ(n = 8): 1 case(12.50%)appeared in the inferior lead.Group Ⅵ(n=5): 3 cases(60.00%),2 cases(40.00%)of inferior wall lead and 1 case(20.00%)of lateral wall lead.5.2 ST segment depression:Group Ⅰ(n=49): 29 cases(59.18%),10 cases(20.41%)appeared in the side wall lead,11cases(22.45%)in the side wall+lower wall lead,and 8 cases(16.33%)in the side wall+high side wall lead.The depression amplitude fluctuated from 0.10 to 0.33 mv.There was no statistical significance in ST segment depression among different hypertrophy groups(P>0.05).Group Ⅱ(n=14): 14 cases(100%),8 cases(57.14%)appeared in the wide anterior wall lead,4 cases(28.57%)in the inferior wall+wide anterior wall lead,2 cases(14.29%)in the high side wall+wide anterior wall lead,and the amplitude of downward movement fluctuated between 0.05 and 0.36 mv.Group Ⅲ(n=6): 5 cases(83.33%),1 case appeared in the lateral wall,1 case in the lateral wall+lower wall and 1 case in the lateral wall+high side wall lead,accounting for 16.67%,2cases in the extensive anterior wall lead(33.33%),and the downward movement fluctuated in0.10-0.32 mv.Group Ⅳ(n=8): 7 cases(87.50%),3 cases(37.50%)appeared in the lateral wall lead,2cases(25.00%)in the lateral wall+lower wall lead,2 cases(25.00%)in the lateral wall+high side wall lead,and the downward movement amplitude fluctuated in 0.10-0.25 mv.Group Ⅴ(n=8): 5 cases(62.50%): 3 cases(37.50%)appeared in the side wall+lower wall lead,2 cases(25.00%)appeared in the side wall+high side wall lead,and the depression amplitude was 0.12-0.25 mv.Group Ⅵ(n=5): 4 cases(80.00%): 2 cases(40.00%)appeared in the side wall lead,1case(20.00%)in the high side wall+side wall lead,1 case(20.00%)in the lower wall+extensive front wall lead,and the depression amplitude was 0.10-0.72 mv.5.3 T wave inversionGroup Ⅰ(n=49): 27 cases(55.10%),4 cases(8.16%),2 cases(4.08%),4 cases(8.16%),and 2 cases(4.08%)of lower wall+wide front wall lead,3 cases(6.12%)of inferior and lateral leads,5 cases(10.20%)of lateral leads and 7 cases(14.29%)of extensive anterior leads.Group Ⅱ(n=14): 14 cases(100%),2 cases(14.29%),4 cases(28.57%)and 8 cases(57.14%)appeared in high side wall+wide front wall lead.Among them,there were 9 cases(64.28%)of GNT,which was the characteristic change,especially in lead V3-V5.The amplitude of T wave fluctuated from 1.00-2.38 mv to 2.38 m V.There were 5 cases(55.56%)with the deepest GNT in lead V4,3 cases(33.33%)with the deepest GNT in lead V5 and 1case with the deepest GNT in lead V3(11.11%),it shows the rule of Tv4≥Tv5≥Tv3.Group Ⅲ(n=6): there were 4 cases(66.67%),including 2 cases(33.33%)with high lateral wall+extensive anterior wall lead,1 case(16.67%)with inferior wall+lateral wall lead and 1 case(16.67%)with lateral wall lead.Group Ⅳ(n=8): there were 6 cases(75.00%),including 2 cases(25.00%)of high lateral wall leads,1 case(12.50%)of high lateral wall plus extensive anterior wall leads,1 case(12.50%)of inferior wall plus extensive anterior wall leads and 2 cases(25.00%)of lateral wall leads.Group Ⅴ(n=8): there were 6 cases(75.00%),including 2 cases(25.00%)of high lateral wall leads,2 cases(25.00%)of high lateral wall plus extensive anterior wall leads,1 case(12.50%)of high lateral wall plus lateral wall leads,and 1 case(12.50%)of lower wall plus lateral wall leads.Group Ⅵ(n=5): 4 cases(80.00%),2 cases(40.00%)appeared in the high lateral wall+lateral wall lead,and 2 cases(40.00%)appeared in the lower wall+extensive anterior wall lead.6.The electrocardiographic characteristics of HCM in rare hypertrophic sites: often combined with different types of arrhythmia,including 6 cases of ventricular arrhythmia(50.0%)and 5 cases of atrial arrhythmia(41.67%).There are 11 cases(91.67%)of ST-segment depression mainly occurred in the anterior thoracic lead,especially in the lateral wall lead(V4-V6).T-wave inversion was found in 9 cases(75.00%),and all leads of thoracic limbs were present.2 cases of abnormal Q wave(16.67%).Conclusion1.In this study,HCM male patients are more than female,and the onset age of female patients was later than that of male patients.The common sites of hypertrophy were interventricular septum,apex of heart,interventricular septum with apex,posterior wall,lateral wall and diffuse distribution.2.Compared with the NOHCM group,the OHCM group had a higher incidence of exertional dyspnea and syncope,as well as a thicker ventricular septum and more severe mitral regurgitation during echocardiography.3.HCM with ventricular arrhythmias and atrial fibrillation are common.Compared with the HCM group without atrial fibrillation,HCM patients with atrial fibrillation had significantly larger LAD,and NYHAⅢ-Ⅳ grade was more common.4.There is no clear correlation between the lead distribution of abnormal Q waves,ST segment depression and T wave inversion and HCM hypertrophy.5.The electrocardiographic characteristics of interventricular septal HCM: ST-segment depression was often found in V4-V6,Ⅱ,Ⅲ,AVF and I,AVL leads,and the amplitude of depression was independent of the degree of hypertrophy.T wave inversion can occur in all leads of thoracic limbs,and abnormal Q wave is more common in leads Ⅱ,Ⅲ and AVF.6.GNT is a characteristic manifestation of AHCM,mainly distributed in leads V3-V5,and the amplitude of huge inverted T wave is generally Tv4≥Tv5≥Tv3. |
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