Clinical research: hypertrophic cardiomyopathy
Sustained cavity obliteration and apical aneurysm formation in apical hypertrophic cardiomyopathy

https://doi.org/10.1016/S0735-1097(03)00576-XGet rights and content
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Abstract

Objectives

In patients with apical hypertrophic cardiomyopathy (ApHCM), we estimated the severity of cavity obliteration (CO) in the apical potion of the left ventricle and correlated it with various clinical findings including apical aneurysm.

Background

Apical hypertrophic cardiomyopathy sometimes develops apical aneurysm. The apical CO is often exhibited in ApHCM along with apical hypertrophy and ischemia. It remains unclear, however, how the CO and others are related to aneurysm.

Methods

In 46 patients with ApHCM, we measured CO time on M-mode echocardiography and corrected it by the R-R interval (cCOT). We divided the 46 patients into the following groups: 17 with cCOT ≤200 ms (no/mild CO group); 18 with cCOT >200 to ≤350 ms (moderate CO group); and 11 with cCOT >350 ms (severe CO group). We then compared apical aneurysm, hypertrophy, ischemia, QT interval, and the like between the three groups.

Results

The severe CO group exclusively comprised 11 patients having apical aneurysm and paradoxic jet flow. Of the 11 patients, 10 exhibited irreversible defects on exercise single photon emission computed tomography with thallium-201. All with moderate CO showed reversible defects, and none with no/mild CO showed any defects. Left ventricular hypertrophy and the corrected QT interval (QTc) were largest in the severe CO group. There were high correlations between the cCOT, hypertrophy, ischemia, and QTc. Of the 11 patients with severe CO, 6 had nonsustained ventricular tachycardia and 1 had mural thrombus.

Conclusions

In ApHCM, sustained CO is an important pathophysiologic condition as well as hypertrophy, ischemia, and prolonged QTc, which are considered jointly related to the development of aneurysm through interactions.

Abbreviations

ApHCM
apical hypertrophic cardiomyopathy
cCOT
cavity obliteration time corrected by the R-R interval
CO
cavity obliteration
E/A ratio
ratio of early transmitral flow velocity to atrial flow velocity
ECG
electrocardiogram/electrocardiography
HCM
hypertrophic cardiomyopathy
LV
left ventricle/ventricular
QTc
corrected QT interval
RWA
relative wall area
201Tl-SPECT
thallium single photon emission computed tomography

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