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Clinical Characteristics and Prognostic Importance of Left Ventricular Apical Aneurysms in

Deacon Z J Lee1, Mahdi Montazeri1, Roxana Bataiosu1

  • 1Division of Cardiology, Peter Munk Cardiac Centre, Department of Medicine, Toronto General Hospital, Toronto, Ontario, Canada.

JACC. Cardiovascular Imaging
|October 6, 2022
PubMed

Insights

Left ventricular apical aneurysms in hypertrophic cardiomyopathy increase the risk of sudden cardiac death and stroke. Larger aneurysms, especially those 2 cm or greater, are associated with significantly poorer outcomes and warrant closer monitoring.

Area of Science:

  • Cardiology
  • Cardiovascular Medicine
  • Genetics

Background:

  • Left ventricular (LV) apical aneurysms are a known risk marker in hypertrophic cardiomyopathy (HCM).
  • Clinical practice and guidelines vary regarding the management and prognosis of this HCM phenotype.

Purpose of the Study:

  • To describe the characteristics, clinical progression, and adverse event risks in a large cohort of HCM patients with LV apical aneurysms.
  • To investigate the relationship between aneurysm size and adverse cardiovascular events.

Main Methods:

  • Analysis of 160 HCM patients with LV apical aneurysms evaluated between January 1997 and April 2021.
  • Longitudinal follow-up to assess rates of sudden cardiac death (SCD), stroke, apical thrombus, and LV systolic dysfunction.

Main Results:

  • Patients with LV apical aneurysms experienced significant rates of SCD (1.77%/y), stroke/thrombus (2.9%/y), and LV dysfunction (1.28%/y).
  • Aneurysm size was a significant predictor of adverse events; each 1-cm increase correlated with higher risk of SCD, stroke/thrombus, and LV dysfunction.
  • Aneurysm size ≥2 cm was associated with a 5-year SCD rate of 9.7% and increased risk of stroke/thrombus.

Conclusions:

  • Increasing LV apical aneurysm size in HCM patients is linked to a worse prognosis.
  • Aneurysm size ≥2 cm should prompt consideration for prophylactic anticoagulation and primary prevention implantable cardioverter-defibrillators (ICDs).
Abstract

Keywords:
cardiovascular magnetic resonance (CMR)echocardiographyhypertrophic cardiomyopathy (HCM)imagingleft ventricular apical aneurysm

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