Prevalence and characteristics of apical aneurysm on cardiovascular magnetic resonance in patients with hypertrophic cardiomyopathy
Eun Kyoung Kim
Hye Bin Gwag
Yeon Hyeon Choe
Seung Woo Park
Radiology and Center for Imaging Science, Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine
Cardiology, Department of Medicine, Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine
From 17th Annual SCMR Scientific Sessions
New Orleans, LA, USA. 16-19 January 2014
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 associated
manifestations of AAn using cardiovascular magnetic
resonance (CMR) in patients with HCM.
A total of 350 consecutive patients diagnosed with HCM
(mean age 54 12, 278 males) underwent CMR and
echocardiography. 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 LGE was
calculated with gray-scale 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.
The prevalence of AAn on CMR was 14.3%, which was
significantly high 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
late gadolinium enhancement were not different
between two groups (frequency; 94% vs. 93.3%, p = 1.00,
extent; 11.7 8.9 vs. 13.0 10.3, p = 0.43).
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.