European Heart Journal Advance Access originally published online on June 14, 2006
European Heart Journal 2006 27(14):1725-1731; doi:10.1093/eurheartj/ehl101
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Interpretation of electrocardiographic abnormalities in hypertrophic cardiomyopathy with cardiac magnetic resonance
1 Department of Cardiology, Juan Canalejo Hospital, Xubias de Arriba 84, 15006 La Coruña, Spain
2 Department of Radiology, Juan Canalejo Hospital, La Coruña, Spain
Received 23 December 2005; revised 17 May 2006; accepted 30 May 2006; online publish-ahead-of-print 14 June 2006.
* Corresponding author. Tel: +34 981 178184; fax: +34 981 178258. E-mail address: lorenzo_monserrat{at}canalejo.org
Aims To clarify the mechanisms of electrocardiographic abnormalities in hypertrophic cardiomyopathy, 102 patients were examined with cardiac magnetic resonance. Distribution and magnitude of hypertrophy and late-enhancement were correlated with electrocardiographic abnormalities.
Methods and results Abnormal Q waves were associated with greater upper anterior septal thickness (22±7 mm vs. 18±5 mm, P=0.001) and increased ratios of upper anterior septum to mean inferolateral (P=0.01), anterolateral (P=0.002), apical (P=0.001), and right ventricular (P=0.001) wall thickness. There was no relation between abnormal Q waves and late-enhancement, except for Q waves 
40 ms (P=0.02). Conduction disturbances and absent septal Q waves were associated with late-enhancement (89 vs. 45%, P=0.01 and 75 vs. 39%, P=0.002, respectively). The depth of negative T waves was related to an increased ratio of the mean thickness between apical and basal level (P=0.01), and to the presence of apical late-enhancement (P=0.03).
Conclusion Abnormal Q waves reflect the interrelation between upper anterior septal thickness and other regions of the left and right ventricles, and wider Q waves are associated with late-enhancement. Conduction disturbances and absent septal Q waves are associated with late-enhancement. The depth of negative T waves is related to craniocaudal asymmetry and apical late-enhancement.
Key Words: Hypertrophy • Cardiomyopathy • Electrocardiography • Magnetic resonance imaging
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