Cardiomyopathy Clinical Trial
Official title:
Morphological and Functional Changes and Prognosis of Subjects With Unexplainable Precordial Deep T-wave Inversion Without Apical Wall Thickness> 15mm
The investigators sought to evaluate the morphological and functional changes and prognosis of participants with unexplainable precordial deep T-wave inversion on ECG and with apical thickness less than 15mm. The conduction of this study was largely due to the increased clinical requirement, which reflected the increased awareness among physicians of missed AHCM.
Apical hypertrophic cardiomyopathy (AHCM) is a special form of non obstructive hypertrophic
cardiomyopathy (HCM), in which the hypertrophy of myocardium predominantly involves the apex
of the left ventricle (LV). Generally, patients with AHCM show obvious negative T waves on
precordial leads on electrocardiogram (ECG). However, clinically some patients present
dramatic T-wave inversion with the apical thickness less than the diagnostic criteria of
AHCM. In order to get a moderate diagnosis, these participants may undergo lengthy
investigation with implications for lifestyle modifications and increase the health care
expenses. The investigators wonder they may share their fate with patients who have overt
AHCM. Further study of these patients is needed for a proper diagnosis and treatment.
In conventional diagnostic criteria published by American heart association (AHA)/American
college of cardiology foundation (ACCF) in 2011, or European society of cardiology (ESC) in
2014, the LV wall thicknessā„15 mm is the unified diagnostic criteria of HCM. These
guidelines, however, did not give additional regulations or instructions for the diagnosis
of AHCM. It is suspected that these criteria may be too strict for AHCM, as the normal left
ventricular wall thins towards the apex and the normal values are lower naturally in the
apical versus the basal segments.
Comparing with echocardiography, the superior spatial and temporal resolution of CMR makes
it more sensitive to diagnose AHCM at earlier stage, much earlier than the appearance of
"ace-of-spades" configuration. In a previous study, only 60% of patients with apical
segmental hypertrophy that were confirmed by CMR were diagnosed by echocardiography.
Echocardiography has its technical limitations for assessing apex due to the limited
regional spatial resolution. Additionally, CMR can offer prognostic features, such as apical
scar and apical aneurysms.
The investigators thus sought to evaluate the morphorage and functional changes and
prognosis of participants with unexplainable precordial deep T-wave inversion on ECG and
with apical thickness less than 15mm.The conduction of this study was largely due to the
increased clinical requirement, which reflected the increased awareness among physicians of
missed AHCM.
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