29th Turkish Cardiology Congress of the Turkish-Society-of-Cardiology (TSC) with International Participation -- OCT 26-29, 2013 -- Antalya, TURKEY[No Abstract Available]Turkish Soc Cardio

Akkoyun, Dursun Çayan

Akyüz, Aydın

Alpsoy, Şeref

Değirmenci, Hasan

Güler, Niyazi

Journal of the American College of Cardiology

English

PubMed

Background and Objectives: The relationship between QT prolongation and myocardial ischemia is widely known. Due to the limited value of ST depression, we aimed to evaluate, by using four simpler heart rate corrections (Bazett, Framingham, Fridericia and Hodges), the value of maximal exercise-QTc prolongation in the diagnosis of coronary artery disease (CAD) presence and severity. Subjects and Methods: We enrolled 234 subjects (mean age 57.3 +/- 9 years, 143 men) who had undergone exercise testing and coronary angiography due to a suspicion of CAD in the study. Evaluating CAD severity with Gensini scoring, the CAD group (n=122) and controls with non-CAD were compared in terms of corrected QT duration at maximal exercise. Results: Age, gender, hypertension, dyslipidemia, smoking, exercise duration, resting, and peak heart rate were similar between the two groups (all p>0.05). The CAD group had higher raw QT values than the controls {268 (169-438) vs. 240 (168-348), p= 350 ms and Fridericia QTc of >= 340 ms were seen to be useful for the diagnosis of CAD, there was no additive diagnostic value of exercise QTc in addition to ST depression. Maximal exercise-QTc Bazett (r=0.163, p=0.01), Framingham (r=0.239, p=0.001), and Fridericia (r=0.206, p=0.001) equations were weakly positively correlated with Gensini scoring. Conclusion: The patients with CAD have longer QTc intervals at peak heart rates during exercise. This finding provides insufficient evidence to support routine incorporation of QTc at peak heart rates into exercise test interpretation

Namik Kemal University Institutional Repository

Korean Circulation Journal

Maximal Exercise-Corrected QT as a Predictor of Coronary Artery Disease: Comparison of Simpler Heart Rate Corrections

Aydın Akyüz

Şeref Alpsoy

Dursun Çayan Akkoyun

Hasan Değirmenci

Niyazi Güler

Crossref

Usefulness of Maximal Exercise-Corrected QT as a Predictor of Coronary Artery Disease: A Comparison of Simpler Heart Rate Corrections

Table 1. Baseline characteristics, biochemical results and Gensini scoring forthe both groups.VariablesCAD groupn¼122 Control group n¼112 P value*Age, years 55.5 9.1 54.9 8.6 0.776Male, n (%) 74(60.6) 69 (61.6) 0.144Female, n (%) 48(39.4) 43 (38.4) 0.156BMI, kg/m2 29(23-41) 29(19-45) 0.235DM, n (%) 28 (22.9) 24(21.4) 0.441Smoking, n (%) 25 (20.4) 21 (18.7) 0.108HT, n (%) 38 (31.1) 34 (30.3) 0.138LDL, mg /dl 13741 13541 0.477HDL, mg/dl 42(26-70) 47(25-87) <0.001TG, mg/dl 170(64-440)124(58-330) 0.008Uric acid, mg/dl 5.2 (1.1-8.3) 4.7(2.4-9.4) 0.009Creatinine, mg /dl 1.0 (0.7-1.4) 0.9(0.3-1.3) 0.568Hemoglobin, mg /dl 13.21.0 13.4 0.9 0.678METs, unit 8.72.3 8.82.4 0.569ST depression 1 mm, n (%) 95 (77.8) 38 (33.9) <0.001Gensini scoring 25(10-128) 2 (0- 4) <0.001Data are presented as meanSD, median (minimum-maximum) values and number/percentage, *Chi-square, Mann Whitney U test and unpaired Student's t-tests, BMI- bodymass index, CAD - coronary artery diseases, DM - diabetes mellitus, HT-hypertension,LDL - low - density lipoprotein, METs– peak metabolic equivalents of exercise test,TG –triglycerideTable-1Age(n)35-44(1309)45-54(988)55-64(887)65-74(572)75(193) TotalECG patternn (female: n)% in agegroup n %(overall)Type 2 6(2)0,5%4(0)0,4%5(0)0,6%4(2)0,7%2(0)1%21(4) 0,5 %Type 3 14(3)1,1%14(1)1.4%14(2)1,6%4(2)0,3%3(0)1,6%47(8) 1,2 %BTEP 20(5)1,5%19(2)1,9%19(2)2,1%8(4)1,0%5(0)2,6%71(13) 1,7%ER inferior 40(15)3,1%30(10)3,0%23(7)2,6%17(8)3,0%2(0)1,0%112(40) 2,8%ER lateral 12(9)0,9%8(6)0,8%7(2)0,8%3(3)0,5%1(1)0,5%31(21) 0,8%ERinferolateral15(4)1,1%1(1)0,1%4(3)0,5%1(1)0,2%00%21(9) 0,5%ERV 67(28)5,1%39(17)3,9%34(12)3,8%21(12)3,7%3(1)1,6%164(70) 4,1%ERV: Early Repolarization Variant BTEP: Brugada Type ECG Pattern n: Number of subjectsORALSOP-155Usefulness of Maximal Exercise-Corrected QT as a Predictor of Coronary ArteryDisease: A Comparison of Simpler Heart Rate CorrectionsAydın Akyüz, Şeref Alpsoy, Dursun Çayan Akkoyun, Hasan Degirmenci, Niyazi GülerNamık Kemal University, Medicine Faculty, TekirdagBackground: The relationship between QT prolongation and myocardial ischemia isknown. Due to the limited value of ST depression, we aimed to evaluate, by using foursimpler heart rate corrections (Bazett, Framingham, Fridericia and Hodges), the valueof maximal exercise-QTc prolongation in the diagnosis of coronary artery disease's(CAD) presence and severity.Methods: We enrolled 234 subjects (mean age 57.39 years, 143 men) whounderwent exercise testing and coronary angiography due to suspicion of CAD in thestudy. The coronary artery was considered diseased if stenosis in a major epicardialcoronary artery was 50 % diameter. Evaluating CAD severity with Gensini scoring,the CAD group (n¼122) and controls with non-CAD were compared in terms ofcorrected QT duration and at maximal exercise.The corrected QT was calculated byusing the following formulae; Bazett's formula QTc¼ QT/RR1/2, Framingham QTc¼QT+ 0.154(1-RR), Fridericia formula QTc¼ QT/RR1/3 and Hodges QTc¼ QT +0.175 (HR-60), respectively.Results: Age, gender, hypertension, dyslipidemia, smoking, exercise duration, restingand peak heart rate were similar between the two groups (All p> 0.05). The CAD grouphave higher raw QT values than the controls (268 [169- 438] vs. 240 [168-348],p<0.001).While Bazett and Hodges formulae were not appropriate at maximal heartrates for diagnosing of CADpresence, FraminghamQTc of350ms and Fridericia QTcof 340 ms were seen to be useful. Maximal exercise-QTc Bazett (r¼0.163, p¼0.01),Framingham (r¼0.239, p¼0.001) and Fridericia (r¼0.206, p¼0.001) equations wereweakly positively correlated with Gensini scoring. There was no correlation betweenHodges QTc at maxima exercise and Gensini scoring (p value>0.05).Conclusion: Measuring with Framingham and Fridericia formulae, are better thanBazett and Hodges at peak heart rates, patients with CAD have longer QTc intervalat peak heart rates during exercise; this finding provides further evidence supportingroutine incorporation of QTc at peak heart rates into exercise test interpretation.JACC Vol 62/18/Suppl C j October 26–29, 2013 j TSC Abstracts/ORALS C69Table 2. Resting and maximal exercise testing findings for the both group.VariablesCAD groupn¼122 Control group n¼112 P value*Resting heart rate, bpm 81(56-101) 85(50-102) 0.118Resting QT, ms 339  34 332  36 0.101Resting QTc, msBazett 390 (311-587) 393 (295-488) 0.865Framingham 378  25 a1 374  27 b1 0.373Fridericia 376(302- 491) a2 374 (279-458) b2 0.409Hodges 394 (311-517) a3 389 (297-490) b3 0.995Resting systolic BP, mmHg 121  15 118 17 0.158Resting diastolic BP, mmHg 81 6 78  8 0.244Resting to peak HR time, min 6.92.6 7.1 2.5 0.376Peak HR, bpm 149 19 150  20 0.861Max. exercise QT, ms 268 (169- 438) 240 (168-348) <0.001Max. exercise QTc, msBazett 405 (290-556) 391 (291-537) 0.015Framingham 360  34 a1 340  29 b1 <0.001Fridericia 350 (235-515) a2 331 (242- 461) b2 0.001Hodges 411 (331-514) a3 409 (325-497) b3 0.601Peak systolic BP, mmHg 190  27 195  26 0.123Peak diastolic BP, mmHg 9512 98  11 0.156bpm- beat per minute, BP- blood pressure, HR- heart rate, min-minute, ms- millisecond, * Chisquare, Mann Whitney U test and unpaired Student's t-tests, paired t test and Wilcoxon ranktest.a1,a2,a3 between resting and maximal exercise in the CAD group(p < 0.001), b1,b2,b3between resting and maximal exercise in the control group (p < 0.001).ORALSOP-156Relationship between Scar Size and Characteristics by ce-CMR and Tpeak-TendInterval in Post-MI Patients with Relatively Preserved LV Functions andNonsustained Ventricular TachycardiaKivanc Yalin1, Ebru Golcuk1, Hakan Buyukbayrak1, Ekrem Bilal Karaayvaz1,Cansu Selcan Akdeniz1, Ravza Yilmaz2, Memduh Dursun2, Ahmet Kaya Bilge1,Kamil Adalet11Istanbul University, Istanbul Faculty of Medicine, Department of Cardiology,Istanbul, 2Istanbul University, Istanbul Faculty of Medicine, Department ofRadiology, IstanbulIntroduction: The Tpeak-Tend (Tpe) interval is an electrocardiographic index oftransmural repolarization dispersion and has been reported to predict life- threateningarrhythmias in the long QT syndrome, Brugada Syndrome, hypertrophic cardiomy-opathy and systolic dysfunction. Infarct tissue size and heterogeneity characterized bycardiac magnetic resonance (CMR) has been shown to be associated with arrhyth-mogenic substrates and sudden cardiac death. Although Tpe intervalis not consideredto reflect structural heart disease, Tpe interval was found to be correlated with extentof non-transmural scar in post-MI patients. However the relationship between peri-infarction zone and scar core percent has never been studied. In this study, we aimedto study the relation between Tpe interval and scar size and characteristics assessedwith CMR in post-MI patients.Methods: This study was enrolled 28 post-MI patients with non-sustained ventriculartachycardia. Tpe interval was defined as the peak or nadir of Twave to the end of Twaveand was measured in each precordial lead by a single blinded observer. All patientsunderwent both cine and contrast enhanced CMR imaging. Left ventricular ejectionfraction (LVEF), scar core, peri-infarct zone and total scar masses were assessed andthese values to LV mass ratios were obtained (Figure). The correlation analysis wasperformed to determine the relationship between Tpe interval and infarct parameters.Results: All of the patients had evidence of scar on late enhanced images. Mean leftventricular ejection fraction was 44.34.2%. Mean scar core (>3SD SI of remotemyocardium) was 3.340.86%, mean peri-infarct zone (2-3 SD SI of remote myocar-dium) 22.488.51% and mean total scar; 25.828.81% respectively. Correlationanalysis showedno correlation between scar core percent (r¼0.233, p¼0.24), peri-infarctzone percent (r¼0.144, p¼0.57) and total scar percent (r¼0.123, p¼0.54) respectively.Conclusion: There was no association between scar size, infarct heterogeneity andTpe interval. Our data suggest that these two modalities may reflect differentarrhythmogenic mechanisms.C70 JACC VOP-157Comparison of Electrocardiographic Criteria in Hypertrophic CardiomyopathyPatients with and without Apical AneurysmEnis Grbovic1, Ozcan Ozeke1, Cagatay Ertan2, Gokhan Keskin3, Bulent Deveci4,Serkan Cay1, Firat Ozcan1, Serkan Topaloglu1, Dursun Aras1, Ahmet Duran Demir2,Sinan Aydogdu11Turkiye Yuksek Ihtisas Hospital, Department of Cardiology, Ankara, 2AcibademUniversity, Department of Cardiology, Eskisehir, 3Acibadem University, Departmentof Cardiology, Ankara, 4Akay Hospital, Department of Cardiology, AnkaraBackground: Apical aneurysms in patients with hypertrophic cardiomyopathy(HCM)represent an underrecognized but clinically important subset of HCM patients,oftenrequiring a high index of suspicion.It is commonly associated with adverse clinicalcourse,including sudden cardiac death and embolic stroke;however it may befrequently missed by echocardiography because of poor image quality of leftventricular apex, particularly between the apical hypertrophic cardiomyopathy (ACM)and mid-ventricular obstructive hypertrophic cardiomyopathy (MVO-HCM). Previousdescriptions of an association of apical aneurysm with ST segment elevation (STE)have been confined to case reports or small patient series.Objectives: We aimed to compare electrocardiographic STE in HCM patients withand without apical aneurysm.Methods: We developed this clinical review using an extensive MEDLINE review ofthe literature and data from our laboratories. By means of 12-lead electrocardiography,we measured the maximal voltage of negative T-wave in all leads, and categorized therepolarization abnormalities as ST-segment depression, STE or isoelectric ST segment(Figure 1).Results: There were 29 ACM patients without apical aneurysm (Group 1; 52.6 17.7years, 69% male) and 28 MVO-HCM patients with apical aneurysm (Group 2;59.613.2years, 57% male). The STE in V4-6 derivations were statistically morefrequent in patients with apical aneurysm compared to those without aneurysm (93% vs7%, p<0,001).There was a positive correlation between the presence of the STE in V4-6 derivations and the presence of the apical aneurysm (Spearman's r¼0.895,P<0.001).Conclusions: Clinicians and specifically echocardiographers must pay special atten-tion on the electrocardiography to correctly detect the frequently overlooked apicalaneurysm in HCM patients, and should be careful for apical aneurysm in the presenceof STE in V4-6 derivations.ol 62/18/Suppl C j October 26–29, 2013 j TSC Abstracts/ORALS

Usefulness of Maximal Exercise- Corrected QT as a Predictor of Coronary Artery Disease: A Comparison of Simpler Heart Rate Corrections

Elsevier - Publisher Connector 

Usefulness of Maximal Exercise-Corrected QT as a Predictor of Coronary Artery Disease: A Comparison of Simpler Heart Rate Corrections 

Table 1. Baseline characteristics, biochemical results and Gensini scoring for
the both groups.
Variables
CAD group
n¼122 Control group n¼112 P value*
Age, years 55.5 9.1 54.9 8.6 0.776
Male, n (%) 74(60.6) 69 (61.6) 0.144
Female, n (%) 48(39.4) 43 (38.4) 0.156
BMI, kg/m2 29(23-41) 29(19-45) 0.235
DM, n (%) 28 (22.9) 24(21.4) 0.441
Smoking, n (%) 25 (20.4) 21 (18.7) 0.108
HT, n (%) 38 (31.1) 34 (30.3) 0.138
LDL, mg /dl 13741 13541 0.477
HDL, mg/dl 42(26-70) 47(25-87) <0.001
TG, mg/dl 170
(64-440)
124(58-330) 0.008
Uric acid, mg/dl 5.2 (1.1-8.3) 4.7(2.4-9.4) 0.009
Creatinine, mg /dl 1.0 (0.7-1.4) 0.9(0.3-1.3) 0.568
Hemoglobin, mg /dl 13.21.0 13.4 0.9 0.678
METs, unit 8.72.3 8.82.4 0.569
ST depression 1 mm, n (%) 95 (77.8) 38 (33.9) <0.001
Gensini scoring 25(10-128) 2 (0- 4) <0.001
Data are presented as meanSD, median (minimum-maximum) values and number/
percentage, *Chi-square, Mann Whitney U test and unpaired Student's t-tests, BMI- body
mass index, CAD - coronary artery diseases, DM - diabetes mellitus, HT-hypertension,
LDL - low - density lipoprotein, METs– peak metabolic equivalents of exercise test,TG –
triglyceride
Table-1
Age
(n)
35-44
(1309)
45-54
(988)
55-64
(887)
65-74
(572)
75
(193) Total
ECG pattern
n (female: n)
% in age
group n %(overall)
Type 2 6(2)
0,5%
4(0)
0,4%
5(0)
0,6%
4(2)
0,7%
2(0)
1%
21(4) 0,5 %
Type 3 14(3)
1,1%
14(1)
1.4%
14(2)
1,6%
4(2)
0,3%
3(0)
1,6%
47(8) 1,2 %
BTEP 20(5)
1,5%
19(2)
1,9%
19(2)
2,1%
8(4)
1,0%
5(0)
2,6%
71(13) 1,7%
ER inferior 40(15)
3,1%
30(10)
3,0%
23(7)
2,6%
17(8)
3,0%
2(0)
1,0%
112(40) 2,8%
ER lateral 12(9)
0,9%
8(6)
0,8%
7(2)
0,8%
3(3)
0,5%
1(1)
0,5%
31(21) 0,8%
ER
inferolateral
15(4)
1,1%
1(1)
0,1%
4(3)
0,5%
1(1)
0,2%
0
0%
21(9) 0,5%
ERV 67(28)
5,1%
39(17)
3,9%
34(12)
3,8%
21(12)
3,7%
3(1)
1,6%
164(70) 4,1%
ERV: Early Repolarization Variant BTEP: Brugada Type ECG Pattern n: Number of subjects
O
R
A
L
SOP-155
Usefulness of Maximal Exercise-Corrected QT as a Predictor of Coronary Artery
Disease: A Comparison of Simpler Heart Rate Corrections
Aydın Akyüz, S¸eref Alpsoy, Dursun Çayan Akkoyun, Hasan Degirmenci, Niyazi Güler
Namık Kemal University, Medicine Faculty, Tekirdag
Background: The relationship between QT prolongation and myocardial ischemia is
known. Due to the limited value of ST depression, we aimed to evaluate, by using four
simpler heart rate corrections (Bazett, Framingham, Fridericia and Hodges), the value
of maximal exercise-QTc prolongation in the diagnosis of coronary artery disease's
(CAD) presence and severity.
Methods: We enrolled 234 subjects (mean age 57.39 years, 143 men) who
underwent exercise testing and coronary angiography due to suspicion of CAD in the
study. The coronary artery was considered diseased if stenosis in a major epicardial
coronary artery was 50 % diameter. Evaluating CAD severity with Gensini scoring,
the CAD group (n¼122) and controls with non-CAD were compared in terms of
corrected QT duration and at maximal exercise.The corrected QT was calculated by
using the following formulae; Bazett's formula QTc¼ QT/RR1/2, Framingham QTc¼
QT+ 0.154(1-RR), Fridericia formula QTc¼ QT/RR1/3 and Hodges QTc¼ QT +
0.175 (HR-60), respectively.
Results: Age, gender, hypertension, dyslipidemia, smoking, exercise duration, resting
and peak heart rate were similar between the two groups (All p> 0.05). The CAD group
have higher raw QT values than the controls (268 [169- 438] vs. 240 [168-348],
p<0.001).While Bazett and Hodges formulae were not appropriate at maximal heart
rates for diagnosing of CADpresence, FraminghamQTc of350ms and Fridericia QTc
of 340 ms were seen to be useful. Maximal exercise-QTc Bazett (r¼0.163, p¼0.01),
Framingham (r¼0.239, p¼0.001) and Fridericia (r¼0.206, p¼0.001) equations were
weakly positively correlated with Gensini scoring. There was no correlation between
Hodges QTc at maxima exercise and Gensini scoring (p value>0.05).
Conclusion: Measuring with Framingham and Fridericia formulae, are better than
Bazett and Hodges at peak heart rates, patients with CAD have longer QTc interval
at peak heart rates during exercise; this ﬁnding provides further evidence supporting
routine incorporation of QTc at peak heart rates into exercise test interpretation.JACC Vol 62/18/Suppl C j October 26–29, 2013 j TSC Abstracts/ORALS C69
Table 2. Resting and maximal exercise testing ﬁndings for the both group.
Variables
CAD group
n¼122 Control group n¼112 P value*
Resting heart rate, bpm 81(56-101) 85(50-102) 0.118
Resting QT, ms 339  34 332  36 0.101
Resting QTc, ms
Bazett 390 (311-587) 393 (295-488) 0.865
Framingham 378  25 a1 374  27 b1 0.373
Fridericia 376(302- 491) a2 374 (279-458) b2 0.409
Hodges 394 (311-517) a3 389 (297-490) b3 0.995
Resting systolic BP, mmHg 121  15 118 17 0.158
Resting diastolic BP, mmHg 81 6 78  8 0.244
Resting to peak HR time, min 6.92.6 7.1 2.5 0.376
Peak HR, bpm 149 19 150  20 0.861
Max. exercise QT, ms 268 (169- 438) 240 (168-348) <0.001
Max. exercise QTc, ms
Bazett 405 (290-556) 391 (291-537) 0.015
Framingham 360  34 a1 340  29 b1 <0.001
Fridericia 350 (235-515) a2 331 (242- 461) b2 0.001
Hodges 411 (331-514) a3 409 (325-497) b3 0.601
Peak systolic BP, mmHg 190  27 195  26 0.123
Peak diastolic BP, mmHg 9512 98  11 0.156
bpm- beat per minute, BP- blood pressure, HR- heart rate, min-minute, ms- millisecond, * Chi
square, Mann Whitney U test and unpaired Student's t-tests, paired t test and Wilcoxon rank
test.a1,a2,a3 between resting and maximal exercise in the CAD group(p < 0.001), b1,b2,b3
between resting and maximal exercise in the control group (p < 0.001).
O
R
A
L
SOP-156
Relationship between Scar Size and Characteristics by ce-CMR and Tpeak-Tend
Interval in Post-MI Patients with Relatively Preserved LV Functions and
Nonsustained Ventricular Tachycardia
Kivanc Yalin1, Ebru Golcuk1, Hakan Buyukbayrak1, Ekrem Bilal Karaayvaz1,
Cansu Selcan Akdeniz1, Ravza Yilmaz2, Memduh Dursun2, Ahmet Kaya Bilge1,
Kamil Adalet1
1Istanbul University, Istanbul Faculty of Medicine, Department of Cardiology,
Istanbul, 2Istanbul University, Istanbul Faculty of Medicine, Department of
Radiology, Istanbul
Introduction: The Tpeak-Tend (Tpe) interval is an electrocardiographic index of
transmural repolarization dispersion and has been reported to predict life- threatening
arrhythmias in the long QT syndrome, Brugada Syndrome, hypertrophic cardiomy-
opathy and systolic dysfunction. Infarct tissue size and heterogeneity characterized by
cardiac magnetic resonance (CMR) has been shown to be associated with arrhyth-
mogenic substrates and sudden cardiac death. Although Tpe intervalis not considered
to reﬂect structural heart disease, Tpe interval was found to be correlated with extent
of non-transmural scar in post-MI patients. However the relationship between peri-
infarction zone and scar core percent has never been studied. In this study, we aimed
to study the relation between Tpe interval and scar size and characteristics assessed
with CMR in post-MI patients.
Methods: This study was enrolled 28 post-MI patients with non-sustained ventricular
tachycardia. Tpe interval was deﬁned as the peak or nadir of Twave to the end of Twave
and was measured in each precordial lead by a single blinded observer. All patients
underwent both cine and contrast enhanced CMR imaging. Left ventricular ejection
fraction (LVEF), scar core, peri-infarct zone and total scar masses were assessed and
these values to LV mass ratios were obtained (Figure). The correlation analysis was
performed to determine the relationship between Tpe interval and infarct parameters.
Results: All of the patients had evidence of scar on late enhanced images. Mean left
ventricular ejection fraction was 44.34.2%. Mean scar core (>3SD SI of remote
myocardium) was 3.340.86%, mean peri-infarct zone (2-3 SD SI of remote myocar-
dium) 22.488.51% and mean total scar; 25.828.81% respectively. Correlation
analysis showedno correlation between scar core percent (r¼0.233, p¼0.24), peri-infarct
zone percent (r¼0.144, p¼0.57) and total scar percent (r¼0.123, p¼0.54) respectively.
Conclusion: There was no association between scar size, infarct heterogeneity and
Tpe interval. Our data suggest that these two modalities may reﬂect different
arrhythmogenic mechanisms.C70 JACC VOP-157
Comparison of Electrocardiographic Criteria in Hypertrophic Cardiomyopathy
Patients with and without Apical Aneurysm
Enis Grbovic1, Ozcan Ozeke1, Cagatay Ertan2, Gokhan Keskin3, Bulent Deveci4,
Serkan Cay1, Firat Ozcan1, Serkan Topaloglu1, Dursun Aras1, Ahmet Duran Demir2,
Sinan Aydogdu1
1Turkiye Yuksek Ihtisas Hospital, Department of Cardiology, Ankara, 2Acibadem
University, Department of Cardiology, Eskisehir, 3Acibadem University, Department
of Cardiology, Ankara, 4Akay Hospital, Department of Cardiology, Ankara
Background: Apical aneurysms in patients with hypertrophic cardiomyopathy(HCM)
represent an underrecognized but clinically important subset of HCM patients,often
requiring a high index of suspicion.It is commonly associated with adverse clinical
course,including sudden cardiac death and embolic stroke;however it may be
frequently missed by echocardiography because of poor image quality of left
ventricular apex, particularly between the apical hypertrophic cardiomyopathy (ACM)
and mid-ventricular obstructive hypertrophic cardiomyopathy (MVO-HCM). Previous
descriptions of an association of apical aneurysm with ST segment elevation (STE)
have been conﬁned to case reports or small patient series.
Objectives: We aimed to compare electrocardiographic STE in HCM patients with
and without apical aneurysm.
Methods: We developed this clinical review using an extensive MEDLINE review of
the literature and data from our laboratories. By means of 12-lead electrocardiography,
we measured the maximal voltage of negative T-wave in all leads, and categorized the
repolarization abnormalities as ST-segment depression, STE or isoelectric ST segment
(Figure 1).
Results: There were 29 ACM patients without apical aneurysm (Group 1; 52.6 
17.7years, 69% male) and 28 MVO-HCM patients with apical aneurysm (Group 2;
59.613.2years, 57% male). The STE in V4-6 derivations were statistically more
frequent in patients with apical aneurysm compared to those without aneurysm (93% vs
7%, p<0,001).There was a positive correlation between the presence of the STE in V4-
6 derivations and the presence of the apical aneurysm (Spearman's r¼0.895,P<0.001).
Conclusions: Clinicians and speciﬁcally echocardiographers must pay special atten-
tion on the electrocardiography to correctly detect the frequently overlooked apical
aneurysm in HCM patients, and should be careful for apical aneurysm in the presence
of STE in V4-6 derivations.ol 62/18/Suppl C j October 26–29, 2013 j TSC Abstracts/ORALS


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Usefulness of Maximal Exercise- Corrected QT as a Predictor of Coronary Artery Disease: A Comparison of Simpler Heart Rate Corrections

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