Ma Fei, Yang Yating, Tao Jingwen, Deng Xiaoyan, Chen Xufeng, Fan Jingjing, Bai Xuelei, Dai Tongyu, Li Sheng, Yang Xiaoyun, Lin Fan
Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Huazhong University of Science and Technology, Wuhan, China.
Front Cardiovasc Med. 2022 Sep 21;9:1004178. doi: 10.3389/fcvm.2022.1004178. eCollection 2022.
Patients with apical hypertrophic cardiomyopathy (ApHCM) have marked inverted T-waves that vary over several years. Inverted T-waves in ApHCM are unstable, but it is unclear whether this change is due to coronary artery disease (CAD) or if it is a characteristic of ApHCM itself. We aimed to study the characteristics of inverted T-waves in patients with ApHCM over the course of 24 h to improve the diagnostic indices of ApHCM.
We examined 83 patients with ApHCM and 89 patients with CAD (who served as the control group). All patients underwent a 24-h dynamic electrocardiogram (ECG). We analyzed the average depth of inverted T-waves per minute and sorted them from shallow to deep; the sorted ECG segments at the 10, 50, and 90 positions of the T-wave were subsequently analyzed.
The amplitudes of inverted T-waves in ApHCM corresponding to the 10, 50, and 90 percentiles were -5.13 ± 4.11, -8.10 ± 4.55, and -10.9 ± 5.04 mm, respectively. Changes in the degree of inverted T-waves were greater in ApHCM than in CAD. T-wave amplitudes in ApHCM were strongly associated with heart rate and circadian rhythm and only weakly associated with CAD and posture. Maximum T-wave amplitudes in the CAD group were <10 mm, while 68% of patients with ApHCM had maximum T-wave amplitudes >10 mm, and all patients with ApHCM aged <50 years had maximum T-wave amplitudes >10 mm.
Notable variations in the T-waves of patients with ApHCM were observed over 24 h. ECG examinations during states of inactivity (comparable to sleep) improved the sensitivity of the diagnosis of ApHCM. Inverted T-wave amplitudes correlated with heart rate and circadian rhythm, where T-wave changes in ApHCM may be due to the normalization of abnormal T-waves effect. Identifying T-wave amplitudes >10 mm can effectively improve the diagnostic rate of ApHCM, especially in patients aged <50 years. The short-term change in T-waves in patients with ApHCM could serve as a novel index that will help in the diagnosis of ApHCM.
肥厚型心肌病心尖部病变（ApHCM）患者有明显的T波倒置，且数年中会发生变化。ApHCM中的T波倒置不稳定，但尚不清楚这种变化是由于冠状动脉疾病（CAD）引起，还是ApHCM本身的一个特征。我们旨在研究ApHCM患者24小时内T波倒置的特征，以提高ApHCM的诊断指标。
我们检查了83例ApHCM患者和89例CAD患者（作为对照组）。所有患者均接受24小时动态心电图（ECG）检查。我们分析每分钟T波倒置的平均深度，并将其从浅到深排序；随后分析T波在第10、50和90位置处排序后的心电图段。
ApHCM中对应于第10、50和90百分位数的T波倒置幅度分别为-5.13±4.11、-8.10±4.55和-10.9±5.04mm。ApHCM中T波倒置程度的变化大于CAD。ApHCM中的T波幅度与心率和昼夜节律密切相关，与CAD和体位的相关性较弱。CAD组中的最大T波幅度<10mm，而68%的ApHCM患者最大T波幅度>10mm，且所有年龄<50岁的ApHCM患者最大T波幅度>10mm。
观察到ApHCM患者的T波在24小时内有显著变化。非活动状态（类似于睡眠）下的心电图检查提高了ApHCM诊断的敏感性。T波倒置幅度与心率和昼夜节律相关，其中ApHCM中的T波变化可能是由于异常T波效应的正常化。识别T波幅度>10mm可有效提高ApHCM的诊断率，尤其是在年龄<50岁的患者中。ApHCM患者T波的短期变化可作为有助于ApHCM诊断的新指标。
