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Left ventricular morphologic progression in apical hypertrophic cardiomyopathy

Mirae Lee1, Alon Shechter2, Donghee Han3

  • 1Division of Cardiology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea; Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.

International Journal of Cardiology
|April 7, 2023
PubMed

Insights

About half of apical hypertrophic cardiomyopathy (AHC) patients show left ventricular (LV) morphology progression, including pouch or aneurysm formation. Advanced AHC types correlate with increased clinical events and scar burden.

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Genetics

Background:

  • Apical hypertrophic cardiomyopathy (AHC) is a form of hypertrophic cardiomyopathy characterized by thickening of the left ventricular apex.
  • The morphologic progression of left ventricular (LV) structures in AHC patients is not well understood.
  • Serial echocardiographic evaluation is crucial for assessing cardiac morphology changes.

Purpose of the Study:

  • To evaluate serial echocardiographic changes in left ventricular (LV) morphology in patients with apical hypertrophic cardiomyopathy (AHC).
  • To investigate the association between LV morphologic progression and adverse clinical events.
  • To determine the relationship between different AHC morphologic types and late gadolinium enhancement (LGE) extent.

Main Methods:

  • Retrospective analysis of serial echocardiograms from 41 AHC patients.
  • Categorization of LV morphology based on apical pouch/aneurysm presence and hypertrophy severity/extent (relative, pure, apical-mid types).
  • Evaluation of clinical events and cardiac magnetic resonance (CMR) LGE extent for each morphologic type.

Main Results:

  • Morphologic changes were observed in 46% of patients, with 27% progressing to more severe hypertrophy types.
  • New apical pouches or aneurysms developed in 12% and 15% of patients, respectively.
  • Patients with advanced morphologic types exhibited higher LGE extent (19% for apical-mid) and increased clinical event rates.

Conclusions:

  • Approximately half of AHC patients experience LV morphologic progression, including apical changes.
  • Advanced AHC morphologic types are linked to greater scar burden and higher rates of adverse clinical events.
  • Serial echocardiography is valuable for monitoring AHC progression and risk stratification.
Abstract

Keywords:
Apical aneurysmApical hypertrophic cardiomyopathyEchocardiography

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