J Waves for Predicting Cardiac Events in Hypertrophic Cardiomyopathy

Abstract

OBJECTIVES This study sought to investigate whether the presence of J waves was associated with cardiac events in patients with hypertrophic cardiomyopathy (HCM).BACKGROUND It has been uncertain whether the presence of J waves predicts life-threatening cardiac events in

Early Repolarization Pattern and Left Ventricular Mass in Hypertrophic Cardiomyopathy

“…5.8%) [15]. There is some discrepancy in the reported prevalence of ERP in patients with HCM, but our results are similar to those of Tsuda et al [5] (46 out of 338 HCM patients, 13.6%) and higher than those reported by Lin et al [16] (8 out of 128 patients, 6.3%). Overall, our findings are of interest and raise the question of whether the abnormal substrate in HCM can favor the appearance of J-waves, which would then act as a surrogate marker for an increased risk of SCD in this population [5].…”

“…Our study raises the hypothesis that greater LVM may represent a pathophysiological link between early repolarization and an increased risk of SCD among patients with HCM [5]. Greater LVM is associated with increased interstitial myocardial fibrosis, which may cause both depolarization and repolarization abnormalities, possibly explaining the appearance of J-waves and its association with SCD.…”

“…Fibrosis and fatty infiltration can result in marked activation delay and create a potential gradient responsible for the ECG pattern [13]. These findings suggest that structural abnormalities are probably intrinsic to J-wave syndromes, which could explain the association between J-waves and SCD in different cardiac abnormalities, including ischemic heart disease [14] and recently HCM [5].…”

“…Several electrocardiographic (ECG) parameters have been reported as potential predictors of SCD in patients with HCM, including QRS fragmentation [3] and T-peak to T-end interval [4]. Recently, J-point elevation in the inferior and/ or lateral leads was shown to be associated with an increased incidence of SCD or ventricular arrhythmias in patients with HCM, and its presence improved prediction of future arrhythmic events in addition to established SCD risk factors [5]. However, the mechanism underlying this association remains to be elucidated and the authors provided no information regarding cardiac magnetic resonance (CMR) data.…”

Electrocardiographic Markers of Fibrosis in Cardiomyopathy: A Beginning of a Long Journey

“…The applicability of ECG in the assessment of risk for adverse events, in another setting than emergency care, has been under major research efforts during the last decade. One interesting Junttila Cardiology 2020;145:309-310 310 DOI: 10.1159/000506507 new comer in this field has been the inferolateral early repolarization (ER) pattern, which has been considered as a normal variant for decades, but has recently been associated with increased risk for cardiac death and SCD in the general population and in many cardiac diseases, including HCM [6][7][8]. At the moment, there is no consensus on whether the slur or notch in the terminal part of the QRS complex is caused by ER of delayed depolarization.…”