Value of Convex-Type ST-Segment Elevation and Abnormal Q Waves for Electrocardiographic-Based Identification of Left Ventricular Remodeling in Hypertrophic Cardiomyopathy

Several studies have demonstrated that the natural course of hypertrophiccardiomyopathy can be variable, often unpredictable with high morbidity andmortality. Therefore, screening for potential cases and periodical evaluation of affectedpatients is compelling. The purpose of our study is to assess a relationship of theelectrocardiographic finding of ST-segment elevation and/or abnormal Q waves withthe development of left ventricular enlargement and wall motion abnormalities in theechocardiography and to propose these findings as a sign of left ventricular remodelingin patients with hypertrophic cardiomyopathy. We enrolled 110 patients withhypertrophic cardiomyopathy. Standard echocardiography and 12-leadelectrocardiograms were analyzed. After initial evaluation, follow up was conductedwith a mean interval of 20.3 months. In the electrocardiograms we found ST-segmentelevation in 43.6% and abnormal Q waves in 18.1%; and left ventricular enlargementin 12.7% and wall motion abnormalities in 21.8% in the echocardiograms. Threedifferent patterns of ST-segment elevation were acknowledged: concave (13.6 %),straight (16.3 %) and convex (13.6%). There was a close relationship between theelectrocardiographic finding of convex ST-segment elevation and/or abnormal Q wavesand the occurrence of left ventricular enlargement and/or wall motion abnormalities inthe echocardiograms with a sensitivity of 62% and a specificity of 85%. However, thestraight and concave-type ST-segment elevation showed a less significant relationshipwith the echocardiographic findings. This study suggested that the electrocardiographicfinding of convex ST-segment elevation and abnormal Q waves could be valuable fordetection of disease progression in patients with hypertrophic cardiomyopathy.