Mechanisms of Abnormal Q Waves in Hypertrophic Cardiomyopathy Assessed by Intracoronary Electrocardiography
Introduction: To clarify the mechanisms of abnormal Q waves in hypertrophic cardiomyopathy (HCM), local epicardial electrical activities were assessed by intracoronary electrocardiography (ECG). Methods and Results: Unipolar intracoronary ECG was recorded by introducing a guide wire for angioplasty...
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| Veröffentlicht in: | Journal of cardiovascular electrophysiology 2004-12, Vol.15 (12), p.1402-1408 |
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| creator | KOGA, YOSHINORI YAMAGA, AKIHIKO HIYAMUTA, KOHJI IKEDA, HISAO TOSHIMA, HIRONORI |
| description | Introduction: To clarify the mechanisms of abnormal Q waves in hypertrophic cardiomyopathy (HCM), local epicardial electrical activities were assessed by intracoronary electrocardiography (ECG).
Methods and Results: Unipolar intracoronary ECG was recorded by introducing a guide wire for angioplasty into the left anterior descending artery (LAD) in 20 patients with HCM and 10 control subjects. Intracoronary ECG showed no Q waves in any control subjects. Intracoronary ECG showed no Q waves in 8 HCM patients without abnormal Q waves on surface ECG. In 12 HCM patients with abnormal Q waves on surface ECG, 4 showed Q waves on intracoronary ECG associated with regional wall‐motion abnormalities, suggesting Q waves are formed by loss of electrical forces due to transmural myocardial fibrosis. The remaining 8 patients, who did not have Q waves on intracoronary ECG, showed greater thickening of the basal free wall than the apical free wall, with no wall‐motion abnormalities. Intracoronary ECG was characterized by increased R or R′ waves and prolonged R peak times at the proximal LAD, suggesting Q waves are formed by increased electrical forces of hypertrophied basal septal and/or ventricular free wall, unopposed by apical forces.
Conclusion: The study findings provide evidence for two mechanisms of abnormal Q waves in HCM: (1) loss of electrical forces due to transmural myocardial fibrosis, and (2) altered direction of resultant initial QRS vector due to increased electrical forces of disproportionate hypertrophy of the basal septal and/or ventricular free wall, unopposed by apical forces. |
| doi_str_mv | 10.1046/j.1540-8167.2004.04314.x |
| format | Article |
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Methods and Results: Unipolar intracoronary ECG was recorded by introducing a guide wire for angioplasty into the left anterior descending artery (LAD) in 20 patients with HCM and 10 control subjects. Intracoronary ECG showed no Q waves in any control subjects. Intracoronary ECG showed no Q waves in 8 HCM patients without abnormal Q waves on surface ECG. In 12 HCM patients with abnormal Q waves on surface ECG, 4 showed Q waves on intracoronary ECG associated with regional wall‐motion abnormalities, suggesting Q waves are formed by loss of electrical forces due to transmural myocardial fibrosis. The remaining 8 patients, who did not have Q waves on intracoronary ECG, showed greater thickening of the basal free wall than the apical free wall, with no wall‐motion abnormalities. Intracoronary ECG was characterized by increased R or R′ waves and prolonged R peak times at the proximal LAD, suggesting Q waves are formed by increased electrical forces of hypertrophied basal septal and/or ventricular free wall, unopposed by apical forces.
Conclusion: The study findings provide evidence for two mechanisms of abnormal Q waves in HCM: (1) loss of electrical forces due to transmural myocardial fibrosis, and (2) altered direction of resultant initial QRS vector due to increased electrical forces of disproportionate hypertrophy of the basal septal and/or ventricular free wall, unopposed by apical forces.</description><identifier>ISSN: 1045-3873</identifier><identifier>EISSN: 1540-8167</identifier><identifier>DOI: 10.1046/j.1540-8167.2004.04314.x</identifier><identifier>PMID: 15610287</identifier><language>eng</language><publisher>350 Main Street , Malden , MA 02148-5018 , USA , and 9600 Garsington Road , Oxford OX4 2DQ , UK: Blackwell Science Inc</publisher><subject>Adult ; Analysis of Variance ; Cardiomyopathy, Hypertrophic - diagnostic imaging ; Cardiomyopathy, Hypertrophic - physiopathology ; Case-Control Studies ; disproportionate hypertrophy ; Echocardiography ; Electrocardiography - methods ; Female ; Humans ; loss of electrical forces ; Male ; Middle Aged ; myocardial fibrosis ; resultant initial QRS vector ; Tomography, Emission-Computed, Single-Photon</subject><ispartof>Journal of cardiovascular electrophysiology, 2004-12, Vol.15 (12), p.1402-1408</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4064-2b9a7de046555ae6291698a8178a2f87950a1e9a852f94eea8a7b1bf48cdb0b73</citedby><cites>FETCH-LOGICAL-c4064-2b9a7de046555ae6291698a8178a2f87950a1e9a852f94eea8a7b1bf48cdb0b73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1046%2Fj.1540-8167.2004.04314.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27903,27904,45554</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15610287$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>KOGA, YOSHINORI</creatorcontrib><creatorcontrib>YAMAGA, AKIHIKO</creatorcontrib><creatorcontrib>HIYAMUTA, KOHJI</creatorcontrib><creatorcontrib>IKEDA, HISAO</creatorcontrib><creatorcontrib>TOSHIMA, HIRONORI</creatorcontrib><title>Mechanisms of Abnormal Q Waves in Hypertrophic Cardiomyopathy Assessed by Intracoronary Electrocardiography</title><title>Journal of cardiovascular electrophysiology</title><addtitle>J Cardiovasc Electrophysiol</addtitle><description>Introduction: To clarify the mechanisms of abnormal Q waves in hypertrophic cardiomyopathy (HCM), local epicardial electrical activities were assessed by intracoronary electrocardiography (ECG).
Methods and Results: Unipolar intracoronary ECG was recorded by introducing a guide wire for angioplasty into the left anterior descending artery (LAD) in 20 patients with HCM and 10 control subjects. Intracoronary ECG showed no Q waves in any control subjects. Intracoronary ECG showed no Q waves in 8 HCM patients without abnormal Q waves on surface ECG. In 12 HCM patients with abnormal Q waves on surface ECG, 4 showed Q waves on intracoronary ECG associated with regional wall‐motion abnormalities, suggesting Q waves are formed by loss of electrical forces due to transmural myocardial fibrosis. The remaining 8 patients, who did not have Q waves on intracoronary ECG, showed greater thickening of the basal free wall than the apical free wall, with no wall‐motion abnormalities. Intracoronary ECG was characterized by increased R or R′ waves and prolonged R peak times at the proximal LAD, suggesting Q waves are formed by increased electrical forces of hypertrophied basal septal and/or ventricular free wall, unopposed by apical forces.
Conclusion: The study findings provide evidence for two mechanisms of abnormal Q waves in HCM: (1) loss of electrical forces due to transmural myocardial fibrosis, and (2) altered direction of resultant initial QRS vector due to increased electrical forces of disproportionate hypertrophy of the basal septal and/or ventricular free wall, unopposed by apical forces.</description><subject>Adult</subject><subject>Analysis of Variance</subject><subject>Cardiomyopathy, Hypertrophic - diagnostic imaging</subject><subject>Cardiomyopathy, Hypertrophic - physiopathology</subject><subject>Case-Control Studies</subject><subject>disproportionate hypertrophy</subject><subject>Echocardiography</subject><subject>Electrocardiography - methods</subject><subject>Female</subject><subject>Humans</subject><subject>loss of electrical forces</subject><subject>Male</subject><subject>Middle Aged</subject><subject>myocardial fibrosis</subject><subject>resultant initial QRS vector</subject><subject>Tomography, Emission-Computed, Single-Photon</subject><issn>1045-3873</issn><issn>1540-8167</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2004</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkFtv1DAQhSMEoqXwF5CfeEuwE9_ygrRatt1WpQgJ1Edr4kzYbJM42FnY_Hu8F5VXpJFmJJ9zxvMlCWE0Y5TLj9uMCU5TzaTKckp5RnnBeLZ_kVw-P7yMM-UiLbQqLpI3IWwpZYWk4nVywYRkNNfqMnn6gnYDQxv6QFxDFtXgfA8d-UYe4TcG0g5kPY_oJ-_GTWvJEnzdun52I0ybmSxCwFg1qWZyO0werPNuAD-TVYc2muxR_9PDuJnfJq8a6AK-O_er5Mf16vtynd5_vbldLu5Ty6nkaV6VoGqMdwohAGVeMllq0ExpyButSkGBYQla5E3JEUGDqljVcG3rilaquEo-nHJH737tMEymb4PFroMB3S4YqZgWQuko1Ceh9S4Ej40ZfdvH3xtGzQG02ZoDT3PgaQ6gzRG02Ufr-_OOXdVj_c94JhsFn06CP22H838Hm7vl6jjGgPQU0IYJ988B4J_iAYUS5vHhxtw9KCXz9dp8Lv4CFkudJA</recordid><startdate>200412</startdate><enddate>200412</enddate><creator>KOGA, YOSHINORI</creator><creator>YAMAGA, AKIHIKO</creator><creator>HIYAMUTA, KOHJI</creator><creator>IKEDA, HISAO</creator><creator>TOSHIMA, HIRONORI</creator><general>Blackwell Science Inc</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200412</creationdate><title>Mechanisms of Abnormal Q Waves in Hypertrophic Cardiomyopathy Assessed by Intracoronary Electrocardiography</title><author>KOGA, YOSHINORI ; YAMAGA, AKIHIKO ; HIYAMUTA, KOHJI ; IKEDA, HISAO ; TOSHIMA, HIRONORI</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4064-2b9a7de046555ae6291698a8178a2f87950a1e9a852f94eea8a7b1bf48cdb0b73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2004</creationdate><topic>Adult</topic><topic>Analysis of Variance</topic><topic>Cardiomyopathy, Hypertrophic - diagnostic imaging</topic><topic>Cardiomyopathy, Hypertrophic - physiopathology</topic><topic>Case-Control Studies</topic><topic>disproportionate hypertrophy</topic><topic>Echocardiography</topic><topic>Electrocardiography - methods</topic><topic>Female</topic><topic>Humans</topic><topic>loss of electrical forces</topic><topic>Male</topic><topic>Middle Aged</topic><topic>myocardial fibrosis</topic><topic>resultant initial QRS vector</topic><topic>Tomography, Emission-Computed, Single-Photon</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>KOGA, YOSHINORI</creatorcontrib><creatorcontrib>YAMAGA, AKIHIKO</creatorcontrib><creatorcontrib>HIYAMUTA, KOHJI</creatorcontrib><creatorcontrib>IKEDA, HISAO</creatorcontrib><creatorcontrib>TOSHIMA, HIRONORI</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of cardiovascular electrophysiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>KOGA, YOSHINORI</au><au>YAMAGA, AKIHIKO</au><au>HIYAMUTA, KOHJI</au><au>IKEDA, HISAO</au><au>TOSHIMA, HIRONORI</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Mechanisms of Abnormal Q Waves in Hypertrophic Cardiomyopathy Assessed by Intracoronary Electrocardiography</atitle><jtitle>Journal of cardiovascular electrophysiology</jtitle><addtitle>J Cardiovasc Electrophysiol</addtitle><date>2004-12</date><risdate>2004</risdate><volume>15</volume><issue>12</issue><spage>1402</spage><epage>1408</epage><pages>1402-1408</pages><issn>1045-3873</issn><eissn>1540-8167</eissn><abstract>Introduction: To clarify the mechanisms of abnormal Q waves in hypertrophic cardiomyopathy (HCM), local epicardial electrical activities were assessed by intracoronary electrocardiography (ECG).
Methods and Results: Unipolar intracoronary ECG was recorded by introducing a guide wire for angioplasty into the left anterior descending artery (LAD) in 20 patients with HCM and 10 control subjects. Intracoronary ECG showed no Q waves in any control subjects. Intracoronary ECG showed no Q waves in 8 HCM patients without abnormal Q waves on surface ECG. In 12 HCM patients with abnormal Q waves on surface ECG, 4 showed Q waves on intracoronary ECG associated with regional wall‐motion abnormalities, suggesting Q waves are formed by loss of electrical forces due to transmural myocardial fibrosis. The remaining 8 patients, who did not have Q waves on intracoronary ECG, showed greater thickening of the basal free wall than the apical free wall, with no wall‐motion abnormalities. Intracoronary ECG was characterized by increased R or R′ waves and prolonged R peak times at the proximal LAD, suggesting Q waves are formed by increased electrical forces of hypertrophied basal septal and/or ventricular free wall, unopposed by apical forces.
Conclusion: The study findings provide evidence for two mechanisms of abnormal Q waves in HCM: (1) loss of electrical forces due to transmural myocardial fibrosis, and (2) altered direction of resultant initial QRS vector due to increased electrical forces of disproportionate hypertrophy of the basal septal and/or ventricular free wall, unopposed by apical forces.</abstract><cop>350 Main Street , Malden , MA 02148-5018 , USA , and 9600 Garsington Road , Oxford OX4 2DQ , UK</cop><pub>Blackwell Science Inc</pub><pmid>15610287</pmid><doi>10.1046/j.1540-8167.2004.04314.x</doi><tpages>7</tpages></addata></record> |
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| subjects | Adult Analysis of Variance Cardiomyopathy, Hypertrophic - diagnostic imaging Cardiomyopathy, Hypertrophic - physiopathology Case-Control Studies disproportionate hypertrophy Echocardiography Electrocardiography - methods Female Humans loss of electrical forces Male Middle Aged myocardial fibrosis resultant initial QRS vector Tomography, Emission-Computed, Single-Photon |
| title | Mechanisms of Abnormal Q Waves in Hypertrophic Cardiomyopathy Assessed by Intracoronary Electrocardiography |
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