Abstract
Recent studies have found that some adverse cardiovascular events could also occur in patients with apical hypertrophic cardiomyopathy (ApHCM), which is different with previous studies suggesting benign nature of this condition. Therefore, the present study aimed to observe the clinical prognosis of ApHCM and to identify the predictors of poor prognosis in clinical, echocardiography and cardiac magnetic resonance (CMR). A total of 126 ApHCM patients with both echocardiography and CMR were identified retrospectively from January 2008 to December 2018. Adverse clinical events were defined as a composite of cardiac death, progressive heart failure, myocardial infarction, thromboembolic stroke, appropriate implantable cardioverter-defibrillator (ICD) interventions for ventricular tachycardia or ventricular fibrillation, and new-onset atrial fibrillation (AF). During a mean follow-up of 96.8 ± 36.0months, clinical events were observed in 34 (27.0%) patients. As compared with patients without clinical events, patients with clinical events were older and had a higher incidence of heart failure. Moreover, patients with clinical events had a higher incidence of non-sustained ventricular tachycardia (NSVT) and had larger left atrial volume index (LAVI), thicker apical thickness, lower peak systolic mitral annular velocity (S') than those without clinical events. In addition, late gadolinium enhancement (LGE) in CMR were more frequently observed in patients with clinical events. Five predictors of poor prognosis were identified: age ≥ 55years, LAVI ≥ 36.7ml/m2, S' ≤ 6.7cm/s, NSVT and LGE. ApHCM was not as benign as expected. Age ≥ 55years, LAVI ≥ 36.7ml/m2, S' ≤ 6.7cm/s along with NSVT and LGE were independent predictors for poor prognosis of ApHCM.
Highlights
Hypertrophic cardiomyopathy (HCM) is a common inherited cardiovascular disease characterized by left ventricular hypertrophy and no other disease that can explain the degree of hypertrophy with the prevalence rate was 0.2% in the general population[1]
It has been reported that Apical hypertrophic cardiomyopathy (ApHCM) has a good prognosis in terms of cardiovascular mortality[5, 6], it has been found in recent years that about one third of ApHCM patients may experience adverse clinical events and potentially life-threatening complications, such as malignant arrhythmia, sudden cardiac death, heart failure, myocardial infarction, atrial fibrillation and stroke[7]
The criteria for the diagnosis of ApHCM included a demonstration of otherwise unexplained left ventricular hypertrophy, confined predominantly to the left ventricular apex below the papillary muscle level, with an apical thickness >15 mm or a ratio of maximal apical to posterior wall thickness >1.5 at the end diastole using standard 2-dimensional transthoracic echocardiography or cardiac magnetic resonance imaging (CMR)[2]. 16 patients were excluded for the following reasons: [1] age
Summary
Hypertrophic cardiomyopathy (HCM) is a common inherited cardiovascular disease characterized by left ventricular hypertrophy and no other disease that can explain the degree of hypertrophy with the prevalence rate was 0.2% in the general population[1]. Apical hypertrophic cardiomyopathy (ApHCM) is a relatively rare subtype of HCM, which mainly involves the left ventricular apex[2]. In the Asian population, ApHCM patients account for about 25% of the total HCM population and 1% to 10% in the non-Asian population[3]. Sakamoto et al first described ApHCM in patients with "giant" T-wave negative and end diastolic left ventricular (LV) ‘‘spade-shaped’’ configuration measured by electrocardiogram and left ventriculography, respectively[4]. The aim of this study is to observe the clinical prognosis of ApHCM and to identify the predictors of poor prognosis in clinical, echocardiographic and cardiac magnetic resonance imaging (CMR)
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Published Version
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