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Diagnosis and Clinical Implication of Left Ventricular Aneurysm in Hypertrophic Cardiomyopathy

Errico Federico Perillo1, Grazia Canciello1, Felice Borrelli1

  • 1Department of Advanced Biomedical Sciences, Federico II University, 80131 Naples, Italy.

Diagnostics (Basel, Switzerland)
|June 10, 2023
PubMed

Insights

Hypertrophic cardiomyopathy (HCM) can cause left ventricular (LV) apical aneurysms, a poor prognostic marker. This review explores the mechanisms, diagnosis, and clinical implications of LV aneurysms in HCM patients.

Area of Science:

  • Cardiology
  • Genetics
  • Pathophysiology

Background:

  • Hypertrophic cardiomyopathy (HCM) is a genetic heart condition with varied presentations.
  • A subset of HCM patients develop left ventricular (LV) apical aneurysms (2-5% prevalence).
  • LV apical aneurysms involve apical dyskinesis/akinesis and scarring, distinct from coronary artery disease.

Purpose of the Study:

  • To review the pathomechanism of LV apical aneurysms in HCM.
  • To discuss diagnostic approaches for LV apical aneurysms.
  • To elucidate the clinical implications and prognostic significance of LV aneurysms in HCM.

Main Methods:

  • Literature review of existing studies on HCM and LV apical aneurysms.
  • Analysis of proposed pathomechanisms, including pressure-induced ischemia.
  • Synthesis of diagnostic criteria and clinical outcomes.

Main Results:

  • The leading hypothesis for LV aneurysm formation involves high systolic intra-aneurysmal pressure and impaired diastolic perfusion.
  • LV apical aneurysm is recognized as a marker of poor prognosis in HCM.
  • The effectiveness of treatments like anticoagulation or ICDs for this specific complication remains unclear.

Conclusions:

  • LV apical aneurysms represent a significant complication of HCM with serious prognostic implications.
  • Further research is needed to clarify the optimal management strategies for patients with HCM and LV apical aneurysms.
  • Understanding the mechanism and diagnosis is crucial for patient care.

Keywords:
anticoagulationarrhythmiashypertrophic cardiomyopathyleft ventricular aneurysm

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