Background: There has been no report of ECG changes
during anginal attacks in patients with coexistent hypertrophic
cardiomyopathy (HCM) and vasospastic angina.
objectives: To elucidate the change in ST-segment during anginal
attacks in patients with coexistent HCM and vasospastic angina (the HCM
group) in comparison with that of patients with vasospastic angina and
no left ventricular hypertrophy (the non-HCM group).
Design: Retrospective study.
Twelve patients in the HCM group, and 28 patients in the non-HCM
Measurements: The direction of ST segment
shift, either ST-segment elevation or depression, on the ECGs recorded
during vasospastic anginal attacks with severe vasoconstriction in the
epicardial coronary artery after intracoronary injection of
Results: Age, male gender, and
distribution of coronary arteries in which the vasospasm occurred were
similar between the two groups. Collateral circulation to the affected
arteries was absent in all the study patients. The prevalence of
anginal attacks associated with ST-segment elevation was 2.7 times
higher in the non-HCM group than in the HCM group (51.5% [17 of 33
attacks] vs 18.8% [3 of 16 attacks], respectively;
p = 0.03).
Conclusions: In the HCM group, myocardial
ischemia associated with a transmural injury pattern seen on the ECG,
which is represented as ST-segment elevation, seldom develops during
vasospastic anginal attacks because of marked left ventricular