PMID- 32576233
OWN - NLM
STAT- MEDLINE
DCOM- 20210111
LR  - 20210111
IS  - 1471-2261 (Electronic)
IS  - 1471-2261 (Linking)
VI  - 20
IP  - 1
DP  - 2020 Jun 23
TI  - Usefulness of ECG to differentiate apical hypertrophic cardiomyopathy from non-ST 
      elevation acute coronary syndrome.
PG  - 306
LID - 10.1186/s12872-020-01592-0 [doi]
LID - 306
AB  - BACKGROUND: Apical hypertrophic cardiomyopathy (ApHCM) is a phenotypic variant of 
      nonobstructive HCM. ApHCM is characterized by left ventricular hypertrophy 
      involve the distal apex. The electrocardiographic character of ApHCM can mimic 
      non-ST elevation acute coronary syndrome (NSTEACS), triggering a series of 
      studies and treatments that may be unnecessary. This study aimed to clarify the 
      electrocardiogram (ECG) differences between the two diseases. METHODS: Initial 
      ECG recordings of 41 patients with ApHCM and 72 patients with NSTEACS were 
      analyzed retrospectively. We analyzed the voltage of negative T (neg T) and R 
      wave, the change of ST-segment as well as the number of leads with neg T wave in 
      the 12-lead ECGs. RESULTS: Across the 12-lead ECGs, the magnitude of R wave 
      significantly differed between ApHCM and NSTEACS in 10 leads excluding leads aVR 
      and V1. ApHCM was associated with a greater maximal amplitude of R wave in lead 
      V5 (3.13 +/- 1.08 vs. 1.38 +/- 0.73 mV, P <  0.001). The magnitude of T wave 
      significantly differed between ApHCM and NSTEACS in 10 leads excluding leads II 
      and V1. ApHCM was associated with a greater maximal amplitude of neg T wave in 
      lead V4 (0.85 +/- 0.69 vs. 0.35 +/- 0.23 mV, P <  0.001). The frequency of giant neg 
      T (1mv or more) wave was higher in ApHCM (36.5% vs. 0%, P <  0.001). The 
      magnitude of ST-segment deviation significantly differed between ApHCM and 
      NSTEACS in 10 leads excluding leads aVF and V2. ApHCM was associated with a 
      greater maximal amplitude of ST-segment depression in lead V5 (0.19 +/- 0.07 vs. 
      0.03 +/- 0.06 mV, P <  0.001). The number of leads with neg T wave also differed 
      between ApHCM and NSTEACS (6.75 +/- 1.42 vs. 6.08 +/- 1.51, P = 0.046). The sum of R 
      wave in lead V5, neg T wave in lead V6 and ST-segment depression in lead 
      V4 > 2.585 mV identified ApHCM with 90.2% sensibility and 87.5% specificity, 
      representing the highest diagnostic accuracy. CONCLUSIONS: Compared with NSTEACS 
      patients, ApHCM patients presented higher R and neg T wave voltage as well as a 
      greater ST-segment depression in the 12-lead ECG. The ECG characteristics can 
      help to differentiate ApHCM from NSTEACS in clinical setting.
FAU - Tao, Yirao
AU  - Tao Y
AD  - Department of Cardiology, The Second Affiliated Hospital of Dalian Medical 
      University, Dalian, Liaoning, China.
FAU - Xu, Jing
AU  - Xu J
AD  - Department of Cardiology, Shanghai East Hospital, Shanghai Tongji University 
      School of Medicine, Shanghai, China.
FAU - Bako, Samira Yerima
AU  - Bako SY
AD  - Department of Cardiology, The Second Affiliated Hospital of Dalian Medical 
      University, Dalian, Liaoning, China.
FAU - Yao, Xiaobo
AU  - Yao X
AD  - Department of Cardiology, Shanghai East Hospital, Shanghai Tongji University 
      School of Medicine, Shanghai, China.
FAU - Yang, Donghui
AU  - Yang D
AUID- ORCID: 0000-0003-4640-357X
AD  - Department of Cardiology, The Second Affiliated Hospital of Dalian Medical 
      University, Dalian, Liaoning, China. yangdonghui1@126.com.
LA  - eng
PT  - Journal Article
DEP - 20200623
PL  - England
TA  - BMC Cardiovasc Disord
JT  - BMC cardiovascular disorders
JID - 100968539
SB  - IM
MH  - *Action Potentials
MH  - Acute Coronary Syndrome/*diagnosis/physiopathology
MH  - Aged
MH  - Aged, 80 and over
MH  - Cardiomyopathy, Hypertrophic/*diagnosis/physiopathology
MH  - Diagnosis, Differential
MH  - *Electrocardiography
MH  - Female
MH  - *Heart Rate
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Non-ST Elevated Myocardial Infarction/*diagnosis/physiopathology
MH  - Predictive Value of Tests
MH  - Retrospective Studies
PMC - PMC7310283
OTO - NOTNLM
OT  - Apical hypertrophic cardiomyopathy
OT  - Electrocardiogram
OT  - Non-ST elevation acute coronary syndrome
COIS- The authors declare that they have no competing interests.
EDAT- 2020/06/25 06:00
MHDA- 2021/01/12 06:00
PMCR- 2020/06/23
CRDT- 2020/06/25 06:00
PHST- 2020/03/31 00:00 [received]
PHST- 2020/06/17 00:00 [accepted]
PHST- 2020/06/25 06:00 [entrez]
PHST- 2020/06/25 06:00 [pubmed]
PHST- 2021/01/12 06:00 [medline]
PHST- 2020/06/23 00:00 [pmc-release]
AID - 10.1186/s12872-020-01592-0 [pii]
AID - 1592 [pii]
AID - 10.1186/s12872-020-01592-0 [doi]
PST - epublish
SO  - BMC Cardiovasc Disord. 2020 Jun 23;20(1):306. doi: 10.1186/s12872-020-01592-0.