CMR Assessment of the Left Ventricle Apical Morphology in Subjects with Giant T-wave Inversions and Without Apical Wall Thickness>15mm

  • Minjie Lu
  • Bailing Wu
  • Yan Zhang
  • Peter Kellman
  • Mehul B Patel
  • Jongmin Lee
  • Shihua Zhao
Poster presentation
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Keywords

Wall Thickness Cardiac Magnetic Resonance Hypertrophic Cardiomyopathy Precordial Lead Left Ventricular Wall Thickness 

Background

Unexplainable giant T-wave inversions in the precordial leads with apical wall thickness <15 mm has been reported. These patients cannot be diagnosed to have apical hypertrophic cardiomyopathy (AHCM) according to the current criteria. The objective of this study was to evaluate the apical morphology of subjects with giant T-wave inversion in the absence of apical wall thickness>15 mm using cardiac magnetic resonance (CMR).

Methods

A total of 60 subjects with giant T-wave inversions and 76 healthy volunteers were enrolled in the study. The segmented left ventricular (LV) wall thickness was measured according the American Heart Association 17-segmented model. The apical angle (apA) as well as the ratios of the segmented thickness to that of basal posterior wall was calculated. The regional variations of LV wall thickness were analyzed among basal, middle and apical walls as well as septum and free wall.

Results

Considerable variation in LV wall thickness in normal subjects was observed across the ventricle with progressive thinning from the base to apex (male and female p < 0.001). The apical thickness of subjects with T wave inversions was 8.10 ± 1.67 mm in male, which is thicker than that of controls (4.14 ± 1.17 mm, p < 0.001). In female the apical thickness also had significant difference as controls (5.85 ± 2.16 mm versus 2.99 ± 0.65 mm p = 0.007). Compared with normals, the apical angle decreased significantly in male (87.44 ± 13.86° vs. 115.03 ± 9.90, p < 0.001) and female (90.69 ± 8.84° vs. 110.07 ± 13.58°, p < 0.001) subjects, respectively.

Conclusions

The apical morphology of subjects with giant T-wave inversion is significantly different from normal, although the absolute thickness of the LV apical wall is below current diagnostic criteria of AHCM. We may propose that it is the apical angle/or the thickness that determines the genesis of precordial T wave inversion. Further investigations are needed to testify whether these subjects should be included within the scope of AHCM or whether this represents a benign new variant.

Copyright information

© Lu et al. 2016

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors and Affiliations

  • Minjie Lu
    • 1
  • Bailing Wu
    • 2
  • Yan Zhang
    • 1
  • Peter Kellman
    • 3
  • Mehul B Patel
    • 4
  • Jongmin Lee
    • 5
  • Shihua Zhao
    • 1
  1. 1.Magnetic Resonance ImagingFuwai HospitalBeijingChina
  2. 2.Radiologythe Second Hospital of Hebei Medical UniversityShijiazhuangChina
  3. 3.Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, National Institutes of HealthUS Department of Health and Human ServicesBethesdaUSA
  4. 4.Baylor College of MedicineHoustonUSA
  5. 5.Radiology, Biomedical Engineering and Medical ScienceKyungpook National University, School of MedicineDaeguKorea (the Democratic People's Republic of)

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