Cardiomyopathy
Significance of Magnetic Resonance Imaging in Apical Hypertrophic Cardiomyopathy

https://doi.org/10.1016/j.amjcard.2010.01.020Get rights and content

Apical hypertrophic cardiomyopathy (HC) is an uncommon variant of nonobstructive HC with peculiar characteristics. The investigators report a series of 13 consecutive Caucasian patients with a suspicion or diagnosis of apical HC on the basis of electrocardiographic and/or echocardiographic findings who prospectively underwent magnetic resonance imaging with late gadolinium enhancement (LGE) evaluation. All but 1 patient presented T-wave inversion in the anterolateral leads on electrocardiogram, with a mean maximum negative T wave of 7.0 ± 3.9 mm. Echocardiography provided correct diagnoses in 9/13 patients (69%), while in 4 patients echocardiographic results were normal or inconclusive. Magnetic resonance imaging showed a spadelike morphology of the left ventricle in 6 patients and identified an apical aneurysm in 4. Eleven patients (85%) presented LGE with a mean percentage of 2.3 ± 2.6% of total left ventricular mass. In 9 (69%) patients LGE was limited to the hypertrophic segments while in 6 (46%) patients it was also present in nonhypertrophic segments. In conclusion, magnetic resonance imaging in patients with apical HC showed a high incidence of apical aneurysms and a peculiar distribution of LGE, that was not limited to hypertrophic segments.

Section snippets

Methods

Thirteen consecutive patients with a suspicion or diagnosis of apical HC on the basis of electrocardiographic and/or echocardiographic findings were prospectively studied with MRI. The diagnosis of spadelike apical HC was based on the published criteria, which include an apical wall thickness ≥15 mm, a ratio ≥1.3 of anterior LV short-axis end-diastolic thickness at the apical level to the basal level, and the presence of spadelike morphology on visual inspection of MRI long-axis images by 2

Results

Our study population consisted of 13 consecutive Caucasian patients (8 men, mean age 55 ± 14 years) with a diagnosis or suspicion of apical HC (Table 1). All patients were referred to our center to undergo echocardiography to investigate an abnormal electrocardiogram. All but 1 patient presented electrocardiographic alterations of the ventricular repolarization in the anterolateral leads in the form of T-wave inversion, with a mean maximum negative T wave of 7.0 ± 3.9 mm. One patient (patient

Discussion

Abnormal electrocardiographic features are often the only disease manifestation in patients with apical HC. Although it is a well-described entity, the diagnosis may frequently be missed using conventional imaging techniques. In line with previous observations7 92% of our patients showed electrocardiographic alterations of the ventricular repolarization in the anterolateral leads, 69% of them with giant inverted T waves, thus confirming the usefulness of electrocardiography as a screening

References (17)

There are more references available in the full text version of this article.

Cited by (0)

View full text