Mid-Ventricular Obstructive Hypertrophic Cardiomyopathy and Apical Aneurysm Mimicking Acute ST-Elevation Myocardial Infarction

A study of the clinical application value of ultrasound and electrocardiogram in the differential diagnosis of cardiomyopathy

OBJECTIVE

To investigate the clinical application values of electrocardiogram (ECG) combined with ultrasound cardiogram (UCG) in the differential diagnosis of cardiomyopathy.

METHODS

A total of 120 patients with cardiomyopathy who were admitted to our hospital were randomly divided into the dilated cardiomyopathy (DCM) group (60 cases) and the ischemic cardiomyopathy (ICM) group (60 cases). Both groups were examined using ECG combined with UCG. The ultrasonic values (aorta, LADI, LVDd, LVESD, RVID, SV, LVEF, LVET, EPSS, E/A, RV6, RV6/RMAX), morphological changes (thin and round left ventricular apex, spherical left ventricle, arch-shaped left ventricle, segmental wall-motion abnormalities (SWMAs), diffuse wall motion abnormalities (DWMAs), paradoxical ventricular wall motion) and heart valve regurgitation (aortic valve, mitral valve, tricuspid valve, pulmonary valve) were compared and analyzed.

RESULTS

The degree of chamber enlargement in the DCM group was remarkably higher than that in the ICM group, but the degree of LVEF and aortic enlargement were significantly lower than those in the ICM group (P<0.05). The detection rates of spherical left ventricle and DWMAs in the DCM group were 60.00% and 100.00% respectively, which was significantly higher than those (6.66% and 40.00%) of the ICM group (P<0.05), but the detection rates of thin and round left ventricular apex, arch-shaped left ventricle, SWMAs, and paradoxical ventricular wall motion were 53.33%, 66.66%, 46.66% and 20.00% respectively in the ICM group, which were markedly higher than those in the DCM group. The incidence rates of aortic valve, mitral valve, tricuspid valve and pulmonary valve in the DCM group were 66.66%, 100.00%, 46.66% and 76.66%, which were notably higher than those (36.66%, 93.33%, 26.66% and 40.00%) in the ICM group (P<0.05).

CONCLUSION

ECG combined with UCG examination can effectively improve the judgment rate and diagnosis accuracy of cardiomyopathy. Due to its high safety, ECG combined with UCG examination is worthy of clinical promotion and application.

Mid-ventricular obstructive hypertrophic cardiomyopathy with apical aneurysm: An important subtype of arrhythmogenic cardiomyopathy

Mid-ventricular obstructive hypertrophic cardiomyopathy (MVOHCM) is an uncommon type of HCM. LV apical aneurysms are present in more than 20% MVOHCM cases and has been identified as an independent predictor of potentially lethal arrhythmic events, including non-sustained or sustained ventricular tachycardia (VT), and ventricular fibrillation (VF), as well as SCD. Although the pathogenesis of LVA remains unknown, but it has been suggested that apical aneurysm may be secondary to the increased after-load and high apical pressure arising from significant pressure gradient of the midventricular obstruction. The scarred rim of the aneurysm and the adjacent areas of LV myocardial fibrosis and consequent apical oxygen-demand mismatch may be responsible for the formation of apical aneurysm. Recent electrophysiologic studies have demonstrated that the aneurysmal rim forms the primary culprit arrhythmogenic substrate for generation of monomorphic ventricular tachycardia leading to SCD, but the clinical significance of the size of aneurysm in relation to SCD remains unsettled. We summarized the clinical features of the patients with MVOHCM and apical aneurysms. Appropriate therapeutic interventions include ICD implantation, and early surgical intervention for gradient relief may be undertaken to relief the MVO.

Left ventricular aneurysms in hypertrophic cardiomyopathy with midventricular obstruction: A systematic review of literature

BACKGROUND

Hypertrophic cardiomyopathy (HCM) with or without left ventricular apical aneurysm (LVA) had been studied in the past. Midventricular obstruction associated with HCM and LVA is a unique entity that has not been distinguished previously as a separate phenotypic disease in HCM patients.

METHODS

A systematic review of Pubmed and Google Scholar was conducted from inception until September 2017 for all observational studies conducted on HCM with midventricular obstruction and LVA.

RESULTS

A total of 94 patients from 39 studies were included in our analysis. The mean age of the patients was 58.05 ± 11.76 years with 59.6% being males. The most common electrocardiographic finding was T wave inversion occurring in 13.8% of the cases followed by ST elevation (9.5%). Maximal left ventricle (LV) wall thickness was reported 18.89 ± 5.19 mm on transthoracic echocardiography and paradoxical jet flow was detected in 29.8% of patients. Beta-blockers (58.5%) were the most common drug therapy at baseline and amiodarone (10.6%) was the most common antiarrhythmic used for ventricular tachycardia (VT). The most common complication, VT, occurred in 39.3% of cases and the incidence of all-cause mortality was 13.8 % over 16 ± 20.1 months follow-up. Implantable cardioverter defibrillator (ICD) was used in 37.2% of patients; 25.7% of patients with ICD received appropriate shock therapy.

CONCLUSION

HCM with LVA and midventricular obstruction is a unique entity that appears to be associated with high incidence of morbidity and mortality. Thus, early diagnosis and therapeutic intervention is recommended for management of this condition.

Sustained ventricular tachycardia as a first manifestation of hypertrophic cardiomyopathy with mid-ventricular obstruction and apical aneurysm in an elderly female patient

Sustained ventricular tachycardia complicating left ventricular apical aneurysms has been reported previously solely in middle-aged patients with hypertrophic cardiomyopathy and mid-cavity obstruction. We report a case of an elderly female patient who presented with incessant ventricular tachycardia as the first clinical manifestation of hypertrophic cardiomyopathy with mid-ventricular obstruction and apical aneurysm.