Apical hypertrophic cardiomyopathy: Clinical follow-up and diagnostic correlates

Abstract

To determine the clinical course of apical hypertrophic cardiomyopathy, 26 patients (mean age 45 years) with asymmetric apical hypertrophy diagnosed by echocardiography or angiography were followed up for an average of 7.3 years (range 1 to 22). Presenting symptoms included atypical chest pain (n = 10), typical angina (n = 6), dyspnea (n = 5) and palpitation (n = 8). Ten patients were asymptomatic. At follow-up all patients had inverted precordial T waves, and 14 had the syndrome of "giant T wave negativity" (greater than or equal to 10 mm). In six patients with electrocardiographic follow-up of greater than 10 years (mean 13.4), precordial T wave inversion had progressed from -0.8 +/- 3.9 to -11.2 +/- 8.0 mm in lead V4 in association with increased QRS amplitude. Episodic atrial fibrillation occurred in 4 of 10 patients with echocardiographic left atrial enlargement. Although left ventricular systolic function was normal, diastolic relaxation was impaired in comparison with values in 10 healthy control subjects: in all 18 patients studied peak filling rate was decreased (4.44 +/- 0.44 versus 6.13 +/- 1.54 stroke volumes/s); time to peak filling was increased (174 +/- 40 versus 147 +/- 32 ms); and atrial systolic contribution to ventricular end-diastolic volume was increased (21.5 +/- 6.8 versus 11.5 +/- 4.6 stroke volume %). During follow-up, 21 of the 26 patients remained in stable condition or were asymptomatic. One patient with normal coronary arteries had an apical myocardial infarction with development of a discrete apical aneurysm and loss of "giant T wave negativity." This patient was the only one to have documented life-threatening ventricular arrhythmias.(ABSTRACT TRUNCATED AT 250 WORDS)

Hypertrophic Cardiomyopathy With Midventricular Obstruction and Apical Aneurysm. A Case Report.

“…Webb et al reported loss of precordial giant T-wave negativity with formation of an apical aneurysm during a 17-year follow-up in a patient with apical hypertrophy and normal coronary arteries. 9 Although the electrocardiogram of the present case was similar to the one that Webb et al reported (Fig 1), it only suggests the complication of apical myocardial aneurysm with left ventricular hypertrophy after loss of giant T-wave negativity.…”

Cardiomiopatia hipertrófica apical associada a doença arterial coronária

“…Poucos são os relatos de casos da forma apical, que evoluíram com infarto agudo do miocárdio (IAM), sem 8,9 ou com aterosclerose associada [10][11][12] . O encontro de angina do peito é comum nos pacientes mais idosos com este tipo de agressão 11 .…”

“…Esta série era composta por pacientes com maior faixa etária (62±11 anos) 11 . Na sé-rie de Webb e col 8 em Toronto, dos 26 pacientes com CMHA, apenas um apresentou aos 33 anos infarto do miocárdio apical e formação de aneurisma, estava em seguimento ambulatorial desde os 17 anos, tendo ocorrido o desaparecimento das alterações da onda T e surgido elevação persistente de supra desnível do segmento ST-T entre V 3 -V 6 . O estudo coronariográfico não evidenciou nenhuma alteração obstrutiva das artérias coronárias, posteriormente desenvolveu arritmia ventricular letal.…”

“…Esta formação aneurismática geralmente surge após o infarto do miocárdio 8 , pode ser devida a obstrução intracavitária médio-ventricular com gradiente de pressão intraventricular que facilita a formação do aneurisma, pelo aumento da pressão apical e/ ou com a redução da pressão de perfusão coronária desta região 21,22 , porém pode não estar relacionada a áreas de infarto 23 ou não estar relacionada a lesão obstrutiva coronária 8 . Foi observado também a associação entre a angina do peito e a presença de fístulas arteriovenosas coronárias em pacientes com CMHA [24][25][26] , ambas as condições poderão ser responsáveis pelos sintomas anginosos, podendo também as fístulas serem causadoras de roubo coronário.…”

Apical Hypertrophic Cardiomyopathy and Hepatitis C Virus Infection

“…This variant of HCM is characterized by giant T wave inversion and an angiographic 'ace-of-spades'-shaped appearance of the left ventricle. In subsequent studies from centers outside Japan, [19][20][21][22][23][24] most of the non-Japanese patients with the apical form of HCM did not have the characteristic giant negative T waves. The reason for the different phenotypic expression of apical hypertrophy in different parts of the world is unknown, but it is most likely related to differences in patient selection.…”