Apical hypertrophic cardiomyopathy with left ventricular apical aneurysm: Importance of multi‐modality imaging

Abstract

Apical hypertrophic cardiomyopathy (HCM) is an uncommon variant of HCM characterized by apical hypertrophy without the septal predominance seen in the majority of HCM cases. In 2% of patients, a concomitant left ventricular apical aneurysm is observed, which increases the risk of sudden death and adverse HCM-related events. Multimodality imaging is helpful for appropriate identification of this particular morphologic pattern. Herein, we present a case of apical HCM with a left ventricular apical aneurysm, exemplifying the utility of a multimodality approach from resting electrocardiogram, transthoracic echocardiogram, left ventriculography, and cardiac magnetic resonance imaging, for proper risk stratification and treatment planning.

Apical myectomy for patients with hypertrophic cardiomyopathy and advanced heart failure

“…13 If an apical aneurysm is suspected, echocardiographic contrast administration or cardiac MRI can clarify apical anatomy. 14,15 Patients who benefit from apical myectomy to augment LV chamber size are those with diastolic heart failure and small LV end-diastolic volume. In our initial experience, we routinely performed left heart catheterization to measure LV pressure and to visualize the LV chamber with contrast ventriculography.…”

Pacemaker Treatment for Apical Hypertrophic Cardiomyopathy in the Setting of an Apical Ventricular Aneurysm

“…ApHCM is an uncommon phenotype of HCM, with an incidence of only 1% to 2% of HCM cases in Western countries, but it accounts for up to 25% of cases in Japan ( 5 , 6 ). In addition, the percentage of concomitant apical aneurysms in patients with ApHCM is 2% in Western countries, but 24% in Japan ( 7 , 8 ). The prognosis of ApHCM seems to be benign, but when it is accompanied by apical aneurysm, it can lead to adverse cardiac events ( 8 ).…”