Sustained cavity obliteration and apical aneurysm formation in apical hypertrophic cardiomyopathy

Matsubara, Kazuo; Nakamura, Takashi; Kuribayashi, Toshiro; Azuma, Akihiro; Nakagawa, Masao

doi:10.1016/s0735-1097(03)00576-x

Cited by 110 publications

(40 citation statements)

References 23 publications

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“…These overall cardiac CT findings demonstrate the potential hemodynamic sequelae of apical hypertrophic cardiomyopathy 1,2. Prior reports describe cases of apical hypertrophic cardiomyopathy with calcified myocardium3; however, the mechanism remains unknown.…”

Section: Discussionmentioning

confidence: 68%

Histologic Sequelae of Apical Hypertrophic Cardiomyopathy: Dystrophic Calcification

Saba

Makaryus

Rahmani

et al. 2017

Clin Med Insights Cardiol

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We present cardiac computed tomography (CT) findings demonstrating apical hypertrophic cardiomyopathy with dystrophic calcification of the left ventricular apex. The absence of significant epicardial coronary artery disease demonstrated by coronary CT angiography suggests that increased wall tension and decreased microvascular perfusion over time account for the dyskinetic apical myocardium, rather than myocardial infarction secondary to atherosclerotic plaque rupture. These observations support CT as the imaging modality of choice to visualize the deposition of calcium in injured myocardial tissue, a recognized occurrence in chronically infarcted myocardium.

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Section: Discussionmentioning

confidence: 68%

Histologic Sequelae of Apical Hypertrophic Cardiomyopathy: Dystrophic Calcification

Saba

Makaryus

Rahmani

et al. 2017

Clin Med Insights Cardiol

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“…Approximately 36% of apical aneurysm cases are found in conjunction with midventricular obstruction and intraventricular pressure gradients [1]. Moreover, several studies have found that apical hypertrophy, which is predominantly characterized by myocardial hypertrophy in the apex, is associated with the occurrence of apical aneurysms with midventricular obstruction [7, 8]. In brief, the elevated pressure may exceed the diastolic coronary blood flow due to the obstruction, resulting in circumferential apical scarring and thinning over time.…”

Section: Discussionmentioning

confidence: 99%

A Rare Case of Hypertrophic Cardiomyopathy with Subendocardial Late Gadolinium Enhancement in an Apical Aneurysm with Thrombus

Morita

Kato

Okano

et al. 2014

Case Reports in Radiology

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The mechanisms responsible for the development of apical aneurysms in cases of hypertrophic cardiomyopathy (HCM) are currently unclear but likely involve multiple factors. Here, we present a case of HCM with marked subendocardial fibrosis involving the apical and proximal portions of the left ventricle. A 71-year-old man with left ventricular hypertrophy presented with signs and symptoms of heart failure. The presence of asymmetrical left ventricular hypertrophy and bilateral, thickened ventricular walls with an apical aneurysm on transthoracic echocardiography suggested a diagnosis of HCM with ventricular dysfunction. No intraventricular pressure gradients with obstruction were identified. Late gadolinium enhancement (LGE) with cardiac magnetic resonance imaging and endomyocardial biopsies showed subendocardial fibrosis involving the apical aneurysm and proximal portion. Whereas LGE in a transmural pattern is commonly observed in HCM apical aneurysms, subendocardial LGE, as noted in the present case, is a relatively rare occurrence. Thus, the present case may provide unique insights into the adverse remodeling process and formation of apical aneurysms in cases of HCM.

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“…It is frequently associated with an apical aneurysm without significant atherosclerotic coronary artery disease 1-7. The mechanisms responsible for apical aneurysm formation are not well understood.…”

Section: Discussionmentioning

confidence: 99%

“…The mechanisms responsible for apical aneurysm formation are not well understood. Major causes of aneurysm formation that have been proposed are increased afterload and high apical pressure, resulting from mid-ventricular obstruction, which lead to compression of the intramyocardial coronary arteries and/or greater oxygen demand due to increased myocardial thickness and decreased oxygen supply due to the decreased capillary network 7. In addition, the apex is subject to greater and sustained systolic stress due to the high pressure gradient.…”

Section: Discussionmentioning

confidence: 99%

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Mid-Ventricular Obstructive Hypertrophic Cardiomyopathy Associated with an Apical Aneurysm: Evaluation of Possible Causes of Aneurysm Formation

et al. 2007

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Mid-ventricular obstructive hypertrophic cardiomyopathy (MVOHCM) is a rare type of cardiomyopathy, associated with apical aneurysm formation in some cases. We report a patient presenting with ventricular fibrillation, an ECG with an above normal ST segment, and elevated levels of cardiac enzymes but normal coronary arteries. Left ventriculography revealed a left ventricular obstruction without apical aneurysm. There was a significant pressure gradient between the apical and basal sites of the left ventricle. Cine magnetic resonance imaging (MRI), performed on the 10th hospital day, showed asymmetric septal hypertrophy, mid-ventricular obstruction, and an apical aneurysm with a thrombus. The first evaluation by contrast-enhanced imaging showed a subendocardial perfusion defect and delayed enhancement. It was speculated that the intraventricular pressure gradient, due to mid-ventricular obstruction, triggered myocardial infarction, which subsequently resulted in apical aneurysm formation.

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Sustained cavity obliteration and apical aneurysm formation in apical hypertrophic cardiomyopathy

Abstract: 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.

Cited by 110 publications

References 23 publications

Histologic Sequelae of Apical Hypertrophic Cardiomyopathy: Dystrophic Calcification

Histologic Sequelae of Apical Hypertrophic Cardiomyopathy: Dystrophic Calcification

A Rare Case of Hypertrophic Cardiomyopathy with Subendocardial Late Gadolinium Enhancement in an Apical Aneurysm with Thrombus

Mid-Ventricular Obstructive Hypertrophic Cardiomyopathy Associated with an Apical Aneurysm: Evaluation of Possible Causes of Aneurysm Formation

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