ABSTRACT
39 patients affected with hypertrophic cardiomyopathy (ICM) have been studied by M-mode and two-dimensional echocardiography (1 and 2D Echo), standard electrocardiogram (ECG) and vectorcardiogram (VCG). For each patient we have outlined the anatomical shape of the left ventricle and we have tried to measure the myocardial hypertrophy by a score system that determines its size and extent. For this reason we have followed the echocardiographic segmental analysis procedure suggested by Edward (1981) but we have modified it dividing the left ventricle into 11 segments and measuring the value of the apex three times. We have given each patient a hypertrophy score by assigning a value 0 to any segment with a thickness less than or equal to 12 mm, a value 1 if the thickness was greater than 12 less than or equal to 17 mm, a value 2 if it was greater than 17 less than or equal to 22 mm, a value 3 if greater than 22 mm. We have also calculated the distribution index of the hypertrophy dividing the number of the hypertrophied segments by the number of the ventricular segments. We have identified five patterns of hypertrophic cardiomyopathy: 7 cases with a partial involvement of the interventricular septum (IVS) (pattern 1), 7 cases with a full involvement of the IVS (pattern 2), 22 cases with involvement of the free wall of the left ventricle (pattern 3), 2 cases with involvement of the distal IVS and the apex (pattern 4), 1 case with involvement of the inferior and lateral wall (pattern 5). The highest hypertrophy score and distribution index was noticed in the third anatomical pattern (p less than 0.001). Comparing the three more frequent anatomical patterns with their Ecg-Vcg aspects, we have found a higher prevalence of the left anterior hemiblock in pattern 1, of the pathological Q waves in pattern 2, of the left ventricular hypertrophy in pattern 3. However this correlation was not significant while the correlation between the Ecg-Vcg aspects and the myocardial hypertrophy score and distribution index was extremely significant (p less than 0.001). Consequently the size and distribution of the myocardial hypertrophy could differentiate the Ecg-Vcg aspects better than the anatomical shape of the left ventricle; when hypertrophy was moderate the left anterior hemiblock and the pathological Q waves were more frequent. On the contrary when hypertrophy was high and widespread the prevailing Ecg-Vcg aspect was the left ventricle hypertrophy.
