Electrocardiographic evolution in patients with hypertrophic cardiomyopathy who develop a left ventricular apical aneurysm

- HCM patients with LV apical aneurysm have a largely unfavourable clinical course.
- We present the first cohort of HCM patients with apical aneurysm and complete ECG follow-up (9 years).
- HCM patients who develop apical aneurysm exhibit ECG changes during apical remodelling.
- ECG alterations may raise the suspicion of apical aneurysm development in HCM patients.
- Suggestive ECGs should prompt MRI and nonstandard echocardiographic views of LV apex.

IntroductionHypertrophic cardiomyopathy (HCM) patients with apical aneurysm have a largely unfavourable clinical course, and are often unrecognised because echocardiography is limited in the assessment of the left ventricular (LV) apex. The aim of this study is the identification of electrocardiographic (ECG) abnormalities associated with the development of apical aneurysm in HCM patients.Materials and methodsElectrocardiographic features were assessed in 14 HCM patients who had a good-quality baseline ECG recorded before and after the diagnosis of apical aneurysm.ResultsDuring follow-up (8.8 ± 7.5 years), the following ECG changes were observed: increase in QRS-complex duration (87 ± 12 ms to 118 ± 34 ms, p = 0.006), QRS-complex fragmentation, decrease in QRS-complex amplitude (SV1 + RV5 -6, from 41 ± 18 mm to 26 ± 11 mm, p = 0.015), ST-segment elevation in V4-V6 (J-point in V5, from − 0.9 ± 1.3 mm to + 0.7 ± 1.3, p = 0.003), positivisation of negative T waves in V3-V6 (T-wave depth in V5, from − 3.4 ± 6.6 to + 3.1 ± 4.1, p = 0.005).ConclusionsHCM patients who develop LV apical aneurysm exhibit distinctive ECG changes along with apical remodelling. Suggestive ECGs should lead the physician to study LV apex by nonstandard echocardiographic views, and perform MRI.