Digital twin reconstruction of ventricular repolarisation identifies regional causes of T-wave abnormalities in hypertrophic cardiomyopathy

The study examined abnormal ventricular repolarisation in patients with hypertrophic cardiomyopathy (HCM) using digital twin technology and data from cardiac magnetic resonance and ECG. Data from 32 healthy volunteers and 69 HCM patients were analysed. Results showed that healthy individuals and HCM patients with normal T-waves had a similar action potential duration gradient of 60 ms. Patients with T-wave abnormalities in regions V1-V3 had a reduced gradient of 30 ms caused by prolongation in the apical part of the heart. Patients with V4-V6 abnormalities had a reversed gradient of -20 ms with more pronounced prolongation in the apical region (94 ms). Despite significant changes in action potential duration, only 6 percent of HCM patients had a prolonged QTc interval. The study demonstrates that different spatial distributions of action potential duration changes cause different ECG phenotypes in HCM.