Association between myocardial hypertrophy and apical diverticulum: more than a coincidence?

Abstract

ORIGINAL ARTICLE PURPOSE We aimed to investigate the possible association between the myocardial hypertrophy and the development of an apical diverticulum. MATERIALS AND METHODSWe retrospectively reviewed 786 multidetector computed tomography (MDCT) coronary angiography examinations (520 males, 266 females; mean age, 57±15 years; age range, 18-78 years). The end-diastolic left ventricle wall thickness was measured in all patients, and a wall thickness of 11 mm was determined to be the cut-off value for myocardial hypertrophy. The ventricular apex and subvalvular area were evaluated for ventricular diverticula. The difference between the apical diverticula in patients with and without myocardial hypertrophy was determined. RESULTSThere were 12 myocardial hypertrophy and nine apical diverticulum cases. Myocardial hypertrophy was observed in four (44%) of nine patients who had apical diverticula, and an apical diverticulum was observed in four (33%) of 12 patients who had myocardial hypertrophy. There was statistically significant difference for myocardial wall thickness between the apical diverticula in patients with myocardial hypertrophy and those without myocardial hypertrophy (P = 0.011). CONCLUSION Diagnosis of apical diverticula has become easier by using imaging modalities such as MDCT. There may be an association between myocardial hypertrophy and apical diverticulum.A pical diverticula are rare cardiac abnormalities consisting of a localized outpouching from the apex of the left ventricle. They are primarily congenital, occurring in isolation or in association with other abnormalities. Noncongenital cases are also seen in an isolated form in adults. A few cases have been described in which there is apparently an association between myocardial hypertrophy and apical diverticula (1-4).Recently, multidetector computed tomography (MDCT) has become a major diagnostic tool in cardiac imaging, showing both the coronary arteries and other cardiac and extracardiac structures, such as the myocardium, cardiac chambers, major vessels, and mediastinum (5). In this study, we investigated the association between myocardial hypertrophy and the development of apical diverticula. Materials and methods Patient selectionWe retrospectively reviewed 786 MDCT coronary angiography examinations performed in our department between October 2009 and May 2012, for the presence of apical diverticula.The institutional ethics committee approved this retrospective study (No: 2012-77 GATA Haydarpaa Teaching Hospital, ‹stanbul, Turkey). Written informed consent was obtained from all patients. Overall, there were 520 men and 266 women, with ages ranging from 18 to 78 years (mean, 57±15 years). The indications for MDCT coronary angiography were suspected coronary artery disease (n=681), coronary artery anomaly (n=36), coronary artery stent patency (n=27), and coronary artery bypass graft assessment (n=42). ImagingThe MDCT coronary angiography examinations were performed using a 64-MDCT scanner (Brilliance-64, Phillips Medical Systems, Eindh...

Non-coronary abnormalities of the left heart: CT angiography findings

“…This appearance can be used to differentiate diverticula from clefts, which are fissure-like protrusions that are confined to the myocardium and left ventricular wall. Left ventricular diverticula are most commonly found in the apical portion of the left ventricle and can be associated with hypertrophic cardiomyopathy ( 26 ) ( Fig. 21 ).…”