Significance of Magnetic Resonance Imaging in Apical Hypertrophic Cardiomyopathy

Apical hypertrophic cardiomyopathy (HC) is an uncommon variant of nonobstructive HC with peculiar characteristics. The investigators report a series of 13 consecutive Caucasian patients with a suspicion or diagnosis of apical HC on the basis of electrocardiographic and/or echocardiographic findings who prospectively underwent magnetic resonance imaging with late gadolinium enhancement (LGE) evaluation. All but 1 patient presented T-wave inversion in the anterolateral leads on electrocardiogram, with a mean maximum negative T wave of 7.0 ± 3.9 mm. Echocardiography provided correct diagnoses in 9/13 patients (69%), while in 4 patients echocardiographic results were normal or inconclusive. Magnetic resonance imaging showed a spadelike morphology of the left ventricle in 6 patients and identified an apical aneurysm in 4. Eleven patients (85%) presented LGE with a mean percentage of 2.3 ± 2.6% of total left ventricular mass. In 9 (69%) patients LGE was limited to the hypertrophic segments while in 6 (46%) patients it was also present in nonhypertrophic segments. In conclusion, magnetic resonance imaging in patients with apical HC showed a high incidence of apical aneurysms and a peculiar distribution of LGE, that was not limited to hypertrophic segments.