Apical hypertrophic cardiomyopathy (apical hypertrophy): an overview

Clinical and laboratory data of apical hypertrophy were reviewed based on our experience of over 200 consecutive patients, of whom 126 patients were followed up by myself for more than 1 year (1 to 29 years). Emphasis was placed on various aspects of electrocardiography including the natural course and "wax and wane" phenomenon of giant negative T waves (GNT). Recent diagnostic modality, i.e., cardiac magnetic resonance imaging was also stressed. Apical hypertrophic cardiomyopathy (apical hypertrophy) was mainly discovered by annual health check including electrocardiography and characterized by giant negative T waves (GNT; -1.0-(-)4.2 mV) in the left precordial leads (V4 or V5) in middle-aged men. Transition from normal T wave to negative T wave required several years and remained usually unchanged thereafter. This change may occur rather abruptly on rare occasions. Disappearance of GNT may also occur slowly and progressively in patients, in whom apical aneurysm had developed. The diagnosis may be obtained with echocardiography, left ventriculography or ultrafast computed tomography, but was most accurate with cardiac magnetic resonance imaging, by which identification of the diversity of hypertrophy was achieved, because the multiple short-axis views were accurately obtained in addition to the exact long-axis view. Hypertrophy was not simple but quite complex in both morphology and grade. Gene abnormality may be present even in cases of apical hypertrophy. The prognosis of apical hypertrophy in Japan has been benign, and heart failure due to atrial fibrillation and left ventricular aneurysm due to the destruction of hypertrophied muscle are thought to have prognostic importance, but these were rare in our series.