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Apical Hypertrophic Cardiomyopathy With Endomyocardial Calcification: A Multimodality Imaging-Based Case Report
Sho Tanabe1, Chisato Takamura1, Masahiro Terashima1
1Cardiology, Cardiovascular Imaging Clinic Iidabashi, Tokyo, JPN.
Cureus
|July 28, 2025
Summary
Apical hypertrophic cardiomyopathy (ApHCM) with endomyocardial calcification is rare. Multimodality imaging revealed apical hypertrophy and calcification, suggesting potential chronic ischemia and guiding clinical management.
Area of Science:
- Cardiology
- Medical Imaging
- Pathophysiology
Background:
- Apical hypertrophic cardiomyopathy (ApHCM) with endomyocardial calcification is infrequently reported, leading to poorly defined imaging characteristics.
- Early detection of ApHCM is crucial for appropriate patient management and prognosis.
Observation:
- A 53-year-old woman presented with abnormal electrocardiographic findings.
- Multimodality imaging, including echocardiography, coronary CT angiography, and cardiac MRI, diagnosed ApHCM with endomyocardial calcification.
Findings:
- Adenosine stress perfusion cardiac MRI revealed a circumferential perfusion defect in the apical myocardium.
- Myocardial strain analysis showed reduced apical global circumferential strain, suggesting possible chronic subendocardial ischemia.
- The presence of calcification was distinguished from thrombus, impacting treatment decisions.
Implications:
- This case highlights the utility of a multimodality imaging approach for diagnosing atypical ApHCM phenotypes.
- Distinguishing calcification from thrombus is critical for preventing unnecessary anticoagulation and optimizing patient care.
- Further research is needed to validate the association between ApHCM, calcification, and chronic ischemia.
Keywords:
apical hcmcardiovascular magnetic resonance imaging (cmr)endomyocardial calcificationmyocardial perfusion reservemyocardial strainMore Related Videos
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