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  • Functional, morphological and electrocardiographical abnormalities in patients with apical hypertrophic cardiomyopathy and apical aneurysm: correlation with cardiac MR

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Heart failure and cardiomyopathies
Functional, morphological and electrocardiographical abnormalities in patients with apical hypertrophic cardiomyopathy and apical aneurysm: correlation with cardiac MR
  1. Kenichiro Suwa1,
  2. Hiroshi Satoh1,2,
  3. Makoto Sano1,
  4. Mamoru Nobuhara1,
  5. Takeji Saitoh1,
  6. Masao Saotome1,
  7. Tsuyoshi Urushida1,
  8. Hideki Katoh1,
  9. Kei Tawarahara1,
  10. Hayato Ohtani1,
  11. Yasushi Wakabayashi1,
  12. Hiroyuki Takase1,
  13. Hajime Terada1,
  14. Yasuo Takehara3,
  15. Harumi Sakahara3 and
  16. Hideharu Hayashi1
  1. 1The Investigator Group, Hamamatsu Circulation Forum; (Hamamatsu Circulation Forum consists of Enshu Hospital, Hamamatsu University Hospital, Hamamatsu Red Cross Hospital, Kosai General Hospital and Seirei Mikatahara Hospital.)
  2. 2Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan
  3. 3Department of Radiology, Hamamatsu University School of Medicine, Hamamatsu, Japan
  1. Correspondence to Dr Hiroshi Satoh; satoh36{at}hama-med.ac.jp

Abstract

Objective The prognosis of apical hypertrophic cardiomyopathy (APH) has been benign, but apical myocardial injury has prognostic importance. We studied functional, morphological and electrocardiographical abnormalities in patients with APH and with apical aneurysm and sought to find parameters that relate to apical myocardial injury.

Methods Study design: a multicentre trans-sectional study. Patients: 45 patients with APH and 5 with apical aneurysm diagnosed with transthoracic echocardiography (TTE) in the database of Hamamatsu Circulation Forum. Measure: the apical contraction with cine-cardiac MR (CMR), the myocardial fibrotic scar with late gadolinium enhancement (LGE)-CMR, and QRS fragmentation (fQRS) defined when two ECG-leads exhibited RSR’s patterns.

Results Cine-CMR revealed 27 patients with normal, 12 with hypokinetic and 11 with dyskinetic apical contraction. TTE misdiagnosed 11 (48%) patients with hypokinetic and dyskinetic contraction as those with normal contraction. Apical LGE was apparent in 10 (83%) and 11 (100%) patients with hypokinetic and dyskinetic contraction, whereas only in 11 patients (41%) with normal contraction (p<0.01). Patients with dyskinetic apical contraction had the lowest left ventricular ejection fraction, the highest prevalence of ventricular tachycardia, and the smallest ST depression and depth of negative T waves. The presence of fQRS was associated with impaired apical contraction and apical LGE (OR=8.32 and 8.61, p<0.05).

Conclusions CMR is superior to TTE for analysing abnormalities of the apex in patients with APH and with apical aneurysm. The presence of fQRS can be a promising parameter for the early detection of apical myocardial injury.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/openhrt-2014-000124

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