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Size Matters. Prevalence and Clinical Implications of Left Ventricular Apical Aneurysms in Hypertrophic

Katie Linden1,2, Nathan Green3, Alison Muir2

  • 1Queen's University Belfast Wellcome-Wolfson Institute for Experimental Medicine Belfast UK.

Journal of the American Heart Association
|July 29, 2025
PubMed

Insights

Left ventricular apical aneurysms (LVAAs) occur in 3% of hypertrophic cardiomyopathy patients. Bigger LVAAs (>2 cm) significantly increase risks of sudden cardiac death, systemic embolization, and left ventricular thrombi.

Area of Science:

  • Cardiology
  • Medical Research

Background:

  • Hypertrophic cardiomyopathy (HCM) is a significant cause of sudden cardiac death.
  • Left ventricular apical aneurysm (LVAA) is a potential complication of HCM.
  • The prevalence and clinical impact of LVAA in HCM require further elucidation.

Purpose of the Study:

  • To systematically review the literature on LVAA prevalence in HCM.
  • To determine the association of LVAA with adverse outcomes including sudden cardiac death, systemic embolization, and heart failure.

Main Methods:

  • Systematic review and meta-analysis of longitudinal, observational studies.
  • Searches included MEDLINE and manual searches up to August 2023.
  • Random-effects model used for data pooling.

Main Results:

  • Pooled prevalence of LVAA in HCM was 3% (95% CI, 2%-5%).
  • Bigger LVAAs (≥2 cm) were associated with significantly higher risks of sudden cardiac death (OR 4.65), left ventricular thrombi (OR 10.92), and a trend towards higher systemic emboli.
  • Small LVAAs (<2 cm) showed a lower prevalence of adverse events compared to bigger LVAAs.

Conclusions:

  • Patients with bigger LVAAs (>2 cm) face the highest risk of poor outcomes in HCM.
  • Targeted primary prevention strategies for sudden cardiac death and systemic embolization may benefit patients with bigger LVAAs.
Abstract

Keywords:
hypertrophic cardiomyopathyleft ventricular apical aneurysmprimary prevention

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