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Reverse septal curvature in hypertrophic cardiomyopathy: Implications for function, structure and arrhythmic risk

Roberto Polizzi1, Grazia Canciello1, Leopoldo Ordine1

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

International Journal of Cardiology
|November 10, 2025
PubMed

Insights

Reverse septal curvature (RSC) in hypertrophic cardiomyopathy (HCM) patients is linked to a distinct phenotype. This includes apical aneurysms, mid-cavity obliteration, and a worse arrhythmic profile, independent of LV aneurysm.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Biomedical Engineering

Background:

  • Reverse septal curvature (RSC) is a recognized marker of increased clinical burden in hypertrophic cardiomyopathy (HCM).
  • The precise mechanical and structural implications of RSC in HCM patients are not fully understood.

Purpose of the Study:

  • To investigate the mechanical and structural implications of RSC in patients with HCM.
  • To determine if RSC is associated with specific cardiac structural changes and functional impairments.

Main Methods:

  • 107 HCM patients underwent 2D echocardiography, 3D echocardiography, and cardiac magnetic resonance (CMR).
  • RSC was defined as left ventricular (LV) mid-septal convexity toward the LV cavity.
  • LV systolic behavior, including cavity and mid-cavity obliteration, was assessed.

Main Results:

  • 49% of patients had RSC, exclusively associated with LV apical aneurysms (20%).
  • RSC patients showed higher rates of sarcomeric mutations, non-sustained ventricular tachycardia (NSVT), greater wall thickness, impaired global longitudinal strain (GLS), and more frequent late gadolinium enhancement.
  • RSC was an independent predictor of NSVT, and mid-cavity obliteration was observed in all RSC patients with reduced apical ejection fraction.

Conclusions:

  • RSC identifies a distinct HCM phenotype, not just an anatomical variant.
  • This phenotype is characterized by apical aneurysms, mid-cavity obliteration, impaired apical function, and a worse arrhythmic profile.
  • These findings are independent of LV aneurysm presence.
Abstract

Keywords:
3D echocardiographyCavity obliterationHypertrophic cardiomyopathyMid-cavity obliterationReverse septal curvature

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