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Li J, Fang J, Liu Y, Wei X. Apical hypertrophic cardiomyopathy: pathophysiology, diagnosis and management. Clin Res Cardiol 2024; 113:680-693. [PMID: 37982860 PMCID: PMC11026226 DOI: 10.1007/s00392-023-02328-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/18/2023] [Indexed: 11/21/2023]
Abstract
Since the first description of apical hypertrophic cardiomyopathy (ApHCM) in 1976, contrasting information from all over the world has emerged regarding the natural history of the disease. However, the recommended guidelines on hypertrophic cardiomyopathy (HCM) pay a cursory reference to ApHCM, without ApHCM-specific recommendations to guide the diagnosis and management. In addition, cardiologists may not be aware of certain aspects that are specific to this disease subtype, and a robust understanding of specific disease features can facilitate recognition and timely diagnosis. Therefore, the review covers the incidence, pathogenesis, and characteristics of ApHCM and imaging methods. Echocardiography and cardiovascular magnetic resonance imaging (CMR) are the most commonly used imaging methods. Moreover, this review presents the management strategies of this heterogeneous clinical entity. In this review, we introduce a novel transapical beating-heart septal myectomy procedure for ApHCM patients with a promising short-time result.
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Affiliation(s)
- Jiangtao Li
- Division of Cardiovascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave., Wuhan, 430030, China
- Key Laboratory of Organ Transplantation, Ministry of Education, Wuhan, China
- NHC Key Laboratory of Organ Transplantation, Ministry of Health, Wuhan, China
| | - Jing Fang
- Division of Cardiovascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave., Wuhan, 430030, China
- Key Laboratory of Organ Transplantation, Ministry of Education, Wuhan, China
- NHC Key Laboratory of Organ Transplantation, Ministry of Health, Wuhan, China
| | - Yani Liu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave., Wuhan, 430030, China.
| | - Xiang Wei
- Division of Cardiovascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave., Wuhan, 430030, China.
- Key Laboratory of Organ Transplantation, Ministry of Education, Wuhan, China.
- NHC Key Laboratory of Organ Transplantation, Ministry of Health, Wuhan, China.
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Sellers SL, Fonte TA, Grover R, Mooney J, Weir-McCall J, Lau KP, Chavda A, McNabney C, Ahmadi A, Blanke P, Payne GW, Murphy DT, Ong K, Taylor CA, Leipsic JA. Hypertrophic Cardiomyopathy (HCM): New insights into Coronary artery remodelling and ischemia from FFR CT. J Cardiovasc Comput Tomogr 2018; 12:467-471. [PMID: 30139668 DOI: 10.1016/j.jcct.2018.08.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 06/11/2018] [Accepted: 08/13/2018] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Angina, myocardial ischemia, and coronary artery physiology in hypertrophic cardiomyopathy (HCM) are poorly understood. However, coronary computed tomography angiography (CCTA) with fractional flow reserve from CT (FFRCT) analysis offers a non-invasive method for evaluation of coronary artery volume to myocardial mass ratio (V/M) that may provide insight into such mechanisms. Thus, we sought to investigate changes in V/M in HCM. METHODS A retrospective analysis was performed on 37 HCM patients and 37 controls matched for age, sex, and cardiovascular risk factors; CCTA-derived coronary artery lumen volume (V) and myocardial mass (M) were used to determine V/M. FFRCT values were calculated for the left anterior descending (LAD), left circumflex (LCx) and right coronary (RCA) arteries as well as the 3-vessel cumulative FFRCT values. RESULTS HCM patients had significantly increased myocardial mass (176 ± 84 vs. 119 ± 27 g, p < 0.0001) and total coronary artery luminal volume (4112 ± 1139 vs. 3290 ± 924 mm3, p < 0.0001) that resulted from increases in segmented luminal volumes of both the left and right coronary artery systems. However, HCM patients had significantly decreased V/M (23.8 ± 5.9 vs. 26.5 ± 5.3 mm3/g; p = 0.026) which was further decreased when restricting V/M analysis to those HCM patients with septal hypertrophy (22.4 mm3/g, p = 0.01) that was mild-moderately predictive of HCM (AUC = 0.68). HCM patients also showed significantly lower nadir FFRCT values in the LCx (0.87 ± 0.06 vs. 0.91 ± 0.06, p = 0.02), and cumulative 3-vessel FFRCT values (2.58 ± 0.18 vs. 2.63 ± 0.14, p = 0.006). CONCLUSIONS HCM patients demonstrate significantly greater coronary volume. Despite this, HCM patients suffer from decreased V/M. Further prospective studies evaluating the relationship between V/M, angina, and heart failure in HCM are needed.
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Affiliation(s)
- Stephanie L Sellers
- Department of Radiology, St Paul's Hospital and University of British Columbia, Vancouver, Canada; Centre for Heart Lung Innovation, St Paul's Hospital and University of British Columbia, Vancouver, Canada
| | | | - Rominder Grover
- Department of Radiology, St Paul's Hospital and University of British Columbia, Vancouver, Canada
| | - John Mooney
- Department of Radiology, St Paul's Hospital and University of British Columbia, Vancouver, Canada
| | - Jonathan Weir-McCall
- Department of Radiology, St Paul's Hospital and University of British Columbia, Vancouver, Canada
| | - Karen Pl Lau
- Department of Radiology, St Paul's Hospital and University of British Columbia, Vancouver, Canada; Centre for Heart Lung Innovation, St Paul's Hospital and University of British Columbia, Vancouver, Canada
| | - Anesh Chavda
- Department of Radiology, St Paul's Hospital and University of British Columbia, Vancouver, Canada
| | - Charis McNabney
- Department of Radiology, St Paul's Hospital and University of British Columbia, Vancouver, Canada
| | - Amir Ahmadi
- Department of Radiology, St Paul's Hospital and University of British Columbia, Vancouver, Canada
| | - Philipp Blanke
- Department of Radiology, St Paul's Hospital and University of British Columbia, Vancouver, Canada
| | | | - Darra T Murphy
- Department of Radiology, St Paul's Hospital and University of British Columbia, Vancouver, Canada
| | - Kevin Ong
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | | | - Jonathon A Leipsic
- Department of Radiology, St Paul's Hospital and University of British Columbia, Vancouver, Canada; Heart Flow Inc, Redwood City, CA, USA; Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, Canada.
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Electrocardiography based prediction of hypertrophy pattern and fibrosis amount in hypertrophic cardiomyopathy: comparative study with cardiac magnetic resonance imaging. Int J Cardiovasc Imaging 2018; 34:1619-1628. [PMID: 29728953 DOI: 10.1007/s10554-018-1365-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 04/29/2018] [Indexed: 01/07/2023]
Abstract
Although, cardiac magnetic resonance imaging (CMR) is a gold standard for risk stratification of hypertrophic cardiomyopathy (HCM), is limited in some situations. We sought to evaluate the predictive power of quantitative electrocardiography in assessing hypertrophy pattern and fibrosis in HCM. Eighty-eight patients with HCM were studied. Voltage of R-S-T waves, number of fragmented QRS (fQRS) complexes, and T wave morphology were measured by 12-lead electrocardiography. Sixteen segmental thickness, late gadolinium enhancement (LGE), native T1, extracellular volume fraction (ECV), and T2, left ventricular (LV) mass and %LGE were measured by CMR. Patterns of LV hypertrophy were classified as pure apical, mixed, or asymmetrical septal hypertrophy. Positive and negative predictive values of biphasic T wave for pure apical type were 70.4 and 63.9%, and the predictive values of precordial negative T wave sums [Formula: see text] 12.5 mm were 69.2 and 79.6%. Precordial S waves, especially Cornell voltage index, were significantly correlated to LV mass index and maximal thickness (p [Formula: see text]0.001). The number of fQRS leads was significantly correlated to %LGE, average ECV, and T2 (all p [Formula: see text]0.001). More than one lead with fQRS could predict [Formula: see text]5% of LGE mass with 58% sensitivity and 63% specificity (p = 0.049, area under the curve = 0.627). However, degree of correlation between maximal thickness and precordial S was poor in cases with fQRS more two leads. T wave morphology and precordial S helps discriminate hypertrophy pattern and maximal hypertrophy, however, in cases with more than two leads of concomitant fQRS, CMR defines fibrosis amount and hypertrophy more accurately.
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Stephenson E, Monney P, Pugliese F, Malcolmson J, Petersen SE, Knight C, Mills P, Wragg A, O'Mahony C, Sekhri N, Mohiddin SA. Ineffective and prolonged apical contraction is associated with chest pain and ischaemia in apical hypertrophic cardiomyopathy. Int J Cardiol 2018; 251:65-70. [PMID: 29197461 DOI: 10.1016/j.ijcard.2017.09.206] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 09/07/2017] [Accepted: 09/25/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To investigate the hypothesis that persistence of apical contraction into diastole is linked to reduced myocardial perfusion and chest pain. BACKGROUND Apical hypertrophic cardiomyopathy (HCM) is defined by left ventricular (LV) hypertrophy predominantly of the apex. Hyperdynamic contractility resulting in obliteration of the apical cavity is often present. Apical HCM can lead to drug-refractory chest pain. METHODS We retrospectively studied 126 subjects; 76 with apical HCM and 50 controls (31 with asymmetrical septal hypertrophy (ASH) and 19 with non-cardiac chest pain and culprit free angiograms and structurally normal hearts). Perfusion cardiac magnetic resonance imaging (CMR) scans were assessed for myocardial perfusion reserve index (MPRi), late gadolinium enhancement (LGE), LV volumes (muscle and cavity) and regional contractile persistence (apex, mid and basal LV). RESULTS In apical HCM, apical MPRi was lower than in normal and ASH controls (p<0.05). In apical HCM, duration of contractile persistence was associated with lower MPRi (p<0.01) and chest pain (p<0.05). In multivariate regression, contractile persistence was independently associated with chest pain (p<0.01) and reduced MPRi (p<0.001). CONCLUSION In apical HCM, regional contractile persistence is associated with impaired myocardial perfusion and chest pain. As apical myocardium makes limited contributions to stroke volume, apical contractility is also largely ineffective. Interventions to reduce apical contraction and/or muscle mass are potential therapies for improving symptoms without reducing cardiac output.
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Affiliation(s)
- Edward Stephenson
- William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Centre at Barts, Queen Mary University of London, London, United Kingdom
| | - Pierre Monney
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Francesca Pugliese
- William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Centre at Barts, Queen Mary University of London, London, United Kingdom; Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - James Malcolmson
- William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Centre at Barts, Queen Mary University of London, London, United Kingdom; Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Steffen E Petersen
- William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Centre at Barts, Queen Mary University of London, London, United Kingdom; Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Charles Knight
- William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Centre at Barts, Queen Mary University of London, London, United Kingdom; Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Peter Mills
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Andrew Wragg
- William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Centre at Barts, Queen Mary University of London, London, United Kingdom; Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | | | - Neha Sekhri
- William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Centre at Barts, Queen Mary University of London, London, United Kingdom; Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Saidi A Mohiddin
- William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Centre at Barts, Queen Mary University of London, London, United Kingdom; Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom.
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Chaturvedi H, Pandey RD, Sharma KK, Makkar JS, Sharma SK. Apical hypertrophic cardiomyopathy with hemodynamically unstable ventricular arrhythmia - Atypical presentation. Indian Heart J 2016; 68 Suppl 2:S202-S206. [PMID: 27751289 PMCID: PMC5067459 DOI: 10.1016/j.ihj.2015.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 07/18/2015] [Accepted: 08/07/2015] [Indexed: 11/25/2022] Open
Abstract
We present a patient with asymptomatic apical hypertrophic cardiomyopathy (AHCM) who recently developed cardiac arrhythmias, and shortly discuss the diagnostic modalities, differential diagnosis, and treatment strategy for this condition. AHCM is a rare form of hypertrophic cardiomyopathy, which usually involves the apex of the left ventricle. AHCM can occur with varied presentations such as chest pain, palpitations, dyspnea, syncope, atrial fibrillation, myocardial infarction, embolic events, ventricular fibrillation, and congestive heart failure. The most peculiar electrocardiogram findings are giant T-waves inversion in the precordial leads with left ventricular (LV) hypertrophy. A transthoracic echocardiogram is the initial diagnostic modality in the evaluation of AHCM and shows hypertrophy of the LV apex. Other diagnostic modalities, including left ventriculography, multislice spiral computed tomography, and cardiac magnetic resonance imagings, are also valuable tools. Medications used to manage include verapamil, beta-blockers, and antiarrhythmic agents. An implantable cardioverter defibrillator (ICD) is recommended for high-risk patients.
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Affiliation(s)
- Hemant Chaturvedi
- Consultant, Non-Invasive Cardiologist, Eternal Heart Care Center & Research Institute, Jaipur, India.
| | - Rudra Dev Pandey
- Consultant Intervention Cardiologist, Eternal Heart Care Center & Research Institute, Jaipur, India
| | - Krishna Kumar Sharma
- FCCP Consultant Pulmonologist, Eternal Heart Care Center & Research Institute, Jaipur, India
| | - Jitendra Singh Makkar
- Consultant Intervention Cardiologist, Eternal Heart Care Center & Research Institute, Jaipur, India
| | - Sanjeev K Sharma
- Consultant Intervention Cardiologist, Eternal Heart Care Center & Research Institute, Jaipur, India
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An S, Fan C, Yan L, Cai C, Yang Y, Zhai S, Zhao S, Liu Y, Duan F, Wang Z, Li Y. Comparison of Long-Term Outcome between Apical and Asymmetric Septal Hypertrophic Cardiomyopathy. Cardiology 2016; 136:108-114. [DOI: 10.1159/000448239] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 07/07/2016] [Indexed: 11/19/2022]
Abstract
Objectives: As reported, diagnostic age, gender and presence of outflow tract obstruction have an impact on prognosis in patients with hypertrophic cardiomyopathy. The aim of this study was to compare the long-term outcome between apical hypertrophic cardiomyopathy (ApHCM) and asymmetric septal hypertrophic cardiomyopathy (ASHCM) after the exclusion of these factors. Methods: A total of 540 patients (270 with ApHCM and 270 with ASHCM) identified in a consecutive single-center cohort were retrospectively studied. The two groups were matched by diagnostic age, gender and the presence of outflow tract obstruction. Clinical characteristics and long-term outcomes were compared. Results: The mean follow-up duration in ASHCM and ApHCM were 6.6 ± 5.5 and 7.6 ± 4.1 years, respectively. During follow-up, 16 patients experienced cardiovascular death in the ASHCM group, while 2 patients experienced cardiovascular death in the ApHCM group (6.3 vs. 0.7%, p < 0.01). Cardiovascular morbidity in the ASHCM and ApHCM groups were 39.9 and 18.5% (p < 0.01). In the multivariate Cox regression analysis late gadolinium enhancement (LGE; HR 4.81, 95% CI 1.28-78.0, p = 0.03) and unexplained syncope (HR 9.68, 95% CI 1.9-17.2, p < 0.01) were independent predictors for cardiovascular mortality. Unexplained syncope was independently associated with a higher risk for sudden cardiac death (HR 4.3, 95% CI 1.2-15.3, p = 0.02). Conclusions: After eliminating the interference of diagnostic age, gender and outflow tract obstruction, ASHCM represented a worse prognosis with a higher incidence of cardiovascular mortality and morbidity than ApHCM. LGE was a strong predictor for cardiovascular death.
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Shin DG, Son JW, Park JY, Choi JW, Ryu SK. Impact of coronary artery anatomy on clinical course and prognosis in apical hypertrophic cardiomyopathy: analysis of coronary angiography and computed tomography. Korean Circ J 2015; 45:38-43. [PMID: 25653702 PMCID: PMC4310978 DOI: 10.4070/kcj.2015.45.1.38] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 09/03/2014] [Accepted: 09/24/2014] [Indexed: 01/24/2023] Open
Abstract
Background and Objectives Apical hypertrophic cardiomyopathy (AHCM) is an uncommon variant of hypertrophic cardiomyopathy with a relatively benign course. However, the prognostic factors of AHCM-particularly those associated with coronary artery disease (CAD) and its anatomical subtypes-are not well known. Subjects and Methods We enrolled 98 consecutive patients with AHCM who underwent coronary angiography or coronary computed tomography scanning at two general hospitals in Korea from January 2002 to March 2012. Patient charts were reviewed for information regarding cardiovascular (CV) risk factors, symptoms, and occurrence of CV events and/or mortality. We also reviewed echocardiographic data and angiography records. Results The mean age at the time of enrollment was 61.45±9.78 years, with female patients comprising 38.6%. The proportions of mixed and pure types of AHCM were 34.4% and 65.6%, respectively. CAD was found in 31 (31.6%) patients. The mean follow-up period was 53.1±60.7 months. CV events occurred in 22.4% of patients, and the mortality rate was 5.1%. The mixed-type was more frequent in CV event group although this difference was not statistically significant (50% vs. 30%, p=0.097). The presence of CAD emerged as an independent risk factor for CV events in univariate and multivariate Cox regression analysis after adjusting for other CV risk factors. Conclusion Coronary artery disease is an independent risk factor for CV events in AHCM patients. However, AHCM without CAD has a benign natural course, comparable with the general population.
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Affiliation(s)
- Dong Geum Shin
- Division of Cardiology, Yonsei Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jung-Woo Son
- Division of Cardiology, Chuncheon Sacred Heart Hospital, Hallym University, Chuncheon, Korea
| | - Ji Young Park
- Division of Cardiology, Department of Internal Medicine, Seoul Eulji Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Jae Woong Choi
- Division of Cardiology, Department of Internal Medicine, Seoul Eulji Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Sung Kee Ryu
- Division of Cardiology, Department of Internal Medicine, Seoul Eulji Hospital, Eulji University School of Medicine, Seoul, Korea
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Yusuf SW, Bathina JD, Banchs J, Mouhayar EN, Daher IN. Apical hypertrophic cardiomyopathy. World J Cardiol 2011; 3:256-9. [PMID: 21860706 PMCID: PMC3158873 DOI: 10.4330/wjc.v3.i7.256] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Revised: 05/21/2011] [Accepted: 07/14/2011] [Indexed: 02/06/2023] Open
Abstract
We describe a patient with asymptomatic apical hypertrophic cardiomyopathy (AHCM) who later developed cardiac arrhythmias, and briefly discuss the diagnostic modalities, differential diagnosis and treatment option for this condition. AHCM is a rare form of hypertrophic cardiomyopathy which classically involves the apex of the left ventricle. AHCM can be an incidental finding, or patients may present with chest pain, palpitations, dyspnea, syncope, atrial fibrillation, myocardial infarction, embolic events, ventricular fibrillation and congestive heart failure. AHCM is frequently sporadic, but autosomal dominant inheritance has been reported in few families. The most frequent and classic electrocardiogram findings are giant negative T-waves in the precordial leads which are found in the majority of the patients followed by left ventricular (LV) hypertrophy. A transthoracic echocardiogram is the initial diagnostic tool in the evaluation of AHCM and shows hypertrophy of the LV apex. AHCM may mimic other conditions such as LV apical cardiac tumors, LV apical thrombus, isolated ventricular non-compaction, endomyocardial fibrosis and coronary artery disease. Other modalities, including left ventriculography, multislice spiral computed tomography, and cardiac magnetic resonance imagings are also valuable tools and are frequently used to differentiate AHCH from other conditions. Medications used to treat symptomatic patients with AHCM include verapamil, beta-blockers and antiarrhythmic agents such as amiodarone and procainamide. An implantable cardioverter defibrillator is recommended for high risk patients.
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Affiliation(s)
- Syed Wamique Yusuf
- Syed Wamique Yusuf, Jaya D Bathina, Jose Banchs, Elie N Mouhayar, Iyad N Daher, Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
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Yang H, Carasso S, Woo A, Jamorski M, Nikonova A, Wigle ED, Rakowski H. Hypertrophy pattern and regional myocardial mechanics are related in septal and apical hypertrophic cardiomyopathy. J Am Soc Echocardiogr 2010; 23:1081-9. [PMID: 20650608 DOI: 10.1016/j.echo.2010.06.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) is associated with considerable phenotypic heterogeneity. Previous studies have shown a relationship between the degree and location of hypertrophy and the prognosis of patients. The aim of this study was to compare left ventricular (LV) circumferential and longitudinal regional mechanics in patients with septal HCM and apical HCM to study the relationship between hypertrophy and function as assessed by myocardial mechanics. METHODS Seventy-two patients with HCM (27 with apical HCM, 45 with septal HCM) were compared with 25 clinically normal and age-matched subjects. Myocardial mechanics were assessed using Velocity Vector Imaging, which extracts myocardial motion estimates from B-mode clips by tracking user-defined points and feature tracking. The Velocity Vector Imaging software generated data on global and regional systolic and diastolic longitudinal and circumferential strain, strain rate, and rotational angle velocities. One-way analysis of variance with post hoc multiple comparisons was used among the three groups. RESULTS Normal subjects had relatively uniform strain and strain rates for all LV segments. Compared with the normal group, patients with septal HCM had decreased LV regional longitudinal strain rates and strain at both the basal and mid septal and lateral segments (all P < .01). Compared with patients with apical HCM, those with septal HCM had higher LV circumferential strain rates and strain at the basal and mid segments (P < .05 to P < .01). There were significant differences in rotational velocities at the mid segments among the three groups (P < .05 to P < .001). CONCLUSIONS Patients with HCM have abnormalities in myocardial mechanics that are related to the site of abnormal myocardial hypertrophy.
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Affiliation(s)
- Hua Yang
- Division of Cardiology, Department of Medicine, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Park SY, Park TH, Kim JH, Baek HK, Seo JM, Kim WJ, Cha KS, Kim MH, Kim YD. Relationship between Giant Negative T-Wave and Severity of Apical Hypertrophy in Patients with Apical Hypertrophic Cardiomyopathy. Echocardiography 2010; 27:770-6. [DOI: 10.1111/j.1540-8175.2010.01152.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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