Electrocardiographic evolution in patients with hypertrophic cardiomyopathy who develop a left ventricular apical aneurysm

Introduction: Hyperfrophic cardiomyopathy (HCM) patients with apical aneurysm have a largely unfavourable clinical course, and are often unrecognised because echocardiography is limited in the assessment of the left ventricular (LV) apex. The aim of this study is the identification of electrocardiographic (ECG) abnormalities associated with the development of apical aneurysm in HCM patients. Materials and methods: Electrocardiographic features were assessed in 14 HCM patients who had a good-quality baseline ECG recorded before and after the diagnosis of apical aneurysm. Results: During follow-up (8.8 +/- 7.5 years), the following ECG changes were observed: increase in QRS-complex duration (87 +/- 12 ms to 118 +/- 34 ms, p = 0.006), QRS-complex fragmentation, decrease in QRS-complex amplitude (SV1 + RV5-6, from 41 +/- 18 mm to 26 +/- 11 mm, p = 0.015), ST-segment elevation in V-4-V-6 (J-point in V-5, from -0.9 +/- 1.3 mm to +0.7 +/- 1.3, p = 0.003), positivisation of negative T waves in V-3-V-6 (T-wave depth in V-5, from -3.4 +/- 6.6 to +3.1 +/- 4.1, p = 0.005). Conclusions: HCM patients who develop LV apical aneurysm exhibit distinctive ECG changes along with apical remodelling. Suggestive ECGs should lead the physician to study LV apex by nonstandard echocardiographic views, and perform MRI. (C) 2015 Elsevier Inc. All rights reserved.