Prevalence and characteristics of apical aneurysm in hypertrophic cardiomyopathy: a prospective analysis of cardiac magnetic resonance findings and clinical outcomes
Eun Kyoung Kim
Yeon Hyeon Choe
Sung Mok Kim
Seung Woo Park
Jae K Oh
th Annual SCMR Scientific Sessions Nice
Cardiovascular Medicine, Mayo Clinic
Radiolgy, Samsung Medical Center / Sungkyunkwan University
Korea (the Republic of
Dept. of cardiovascular Meidicine, Samsung Medical Center / Sungkyunkwan Unicersity
Korea (the Republic of
Hypertrophic cardiomyopathy (HCM) with apical
aneurysm (AAn) is associated with considerable morbidity
and mortality. However, the real incidence of AAn
tends to be underrecognized due to the poor
visualization of left ventricular (LV) apex with echocardiography.
This study sought to investigate the exact incidence and
clinical manifestations of AAn in patients with HCM.
A total of 350 consecutive patients diagnosed with HCM
(mean age 54 12, 278 males) underwent cardiac
magnetic resonance (CMR) and echocardiography. All enrolled
patients were prospectively followed up for adverse clinical
events including cardiac death, admission for heart failure
and cerebrovascular accident. We divided the subjects into
4 phenotypes according to the location of hypertrophic
segment; asymmetrical septal hypertrophy (ASH), apical,
concentric and septal/apical type. On CMR, the LV
volumetric parameters were measured, and the amount of late
gadolinium enhancement (LGE) was calculated with
grayscale thresholds of 6 SD above the mean signal intensity
for normal remote myocardium. Echocardiographic
evaluations included left atrial volume index, mitral inflow
pattern, tissue Doppler of mitral annulus and LV
dimension. Median follow up duration was 37 months.
1Dept. of cardiovascular Meidicine, Samsung Medical Center /
Sungkyunkwan Unicersity, Seoul, Korea (the Republic of
Full list of author information is available at the end of the article
The prevalence of AAn on CMR was 14.3%, which was
significantly higher compared to previously reported data.
AAn was detected in all groups of HCM regardless of type
(16.8% in ASH type, 15.3% in apical type, 17.9% in
concentric type, and 9.1% in septal/apical type of HCM).
Clinical manifestations and LV volumetric parameters on
CMR did not differ between the HCM patients with and
without AAn. The frequency and the amount of LGE were
not different between two groups (frequency; 94% vs.
93.3%, p=1.00, extent; 11.78.9 vs. 13.010.3, p=0.43).
During follow up, the frequency of adverse clinical events
did not differ between patients with and without AAn
The incidence of AAn in HCM patients was far higher
than it was reported previously. Regardless of presence of
AAn, initial manifestations and associated morphology of
LV were similar. This means that adverse clinical
outcomes in HCM patients with AAn may be a long-range
problem which arises from secondary myocardial changes
due to AAn.