Computerized Q wave dimensions in athletes and hypertrophic cardiomyopathy patients

•Q waves due to septal hypertrophy have been associated with hypertrophic cardiomyopathy.•Q waves of 40 ms duration or greater or greater than 3 mm depth in the inferior and lateral leads have been considered an abnormal finding requiring evaluation to rule out hypertrophic cardiomyopathy prior to participation in competitive sports.•Our computerized measurement of Q waves suggests that Q waves, particularly in limb lead I, have discriminatory characteristics to distinguish Q waves in healthy athletes from patients with hypertrophic cardiomyopathy. This requires validation in other better matched populations.

BackgroundThere is controversy regarding Q wave criteria for assessing risk for hypertrophic cardiomyopathy (HCM) in young athletes.MethodsThe 12-lead ECGs from Preparticipation screening in healthy athletes and patients with HCM were studied retrospectively. All 12 leads were measured using the same automated ECG analysis program.ResultsThere were a total of 225 HCM patients and 1124 athletes with 12-lead electrocardiograms available for analysis. Athletes were on average 20 years of age, 65% were male and 24% were African–American. Patients with HCM were on average 51 years of age, 56% were male and 5.8% were African–American. Q waves by either amplitude, duration or area criteria were more prevalent in males than females, in lateral leads than inferior and in HCM patients than athletes. The most striking difference in Q waves between the groups was in Limb lead I and in the females. Tall, skinny Q waves were rare in athletes and had the highest prevalence of only 3.7% in male HCM patients.ConclusionQ waves are more common in males compared to females and in patients with HCM compared to athletes. Q waves of 30 ms or more in limb lead I appear to offer the greatest discriminatory value for separating patients with HCM from athletes.