Apical Hypertrophic Cardiomyopathy: The Variant Less Known

Hughes, Rebecca; Knott, Kristopher; Malcolmson, James; Augusto, João; Mohiddin, Saidi A; Kellman, Peter; Moon, James; Captur, Gabriella

doi:10.1161/jaha.119.015294

Cited by 109 publications

(164 citation statements)

References 48 publications

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“…Definition of ApHCM relies on demonstrating left ventricular hypertrophy predominating in the distal apex by cardiovascular magnetic resonance imaging or echocardiography, with a wall thickness ≥ 4 15 mm of the apex and maximal apical/posterior wall ratio ≥ 1.5 [14,15] .…”

Section: Aphcm Groupmentioning

confidence: 99%

Usefulness of ECG to differentiate apical hypertrophic cardiomyopathy from non-ST elevation acute coronary syndrome

Tao

Bako

et al. 2020

Preprint

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Objective: Apical hypertrophic cardiomyopathy (ApHCM) is a phenotypic variant of nonobstructive HCM. ApHCM is characterized by left ventricular hypertrophy involve the distal apex. The electrocardiographic character of ApHCM can mimic non-ST elevation acute coronary syndrome (NSTEACS) which triggers a series of studies and treatments that may be unnecessary. This study aimed to clarify the ECG differences between the two diseases.Methods: Initial electrocardiogram (ECG) recordings of 41 patients with ApHCM and 72 patients with NSTEACS were analyzed retrospectively. We analyzed the voltage of negative T (neg T) wave, R wave and the change of ST-segment in the 12-lead ECGs as well as the number of leads with neg T waves.Results: Across the 12-lead ECGs, the magnitude of R wave significantly differed between ApHCM and NSTEACS in 10 leads excluding leads aVR and V1. ApHCM was associated with a greater maximal amplitude of R wave in lead V5 (3.13±1.08 vs. 1.38±0.73, P=0.000). The magnitude of T wave significantly differed between ApHCM and NSTEACS in 10 leads excluding leads II and V1. ApHCM was associated with a greater maximal amplitude of neg T wave in lead V4 (0.85±0.69 vs. 0.35±0.23, P=0.000). The frequency of giant neg T (1mv or more) wave was higher in ApHCM (36.5% vs. 0%, P=0.000). The magnitude of ST-segment deviation significantly differed between ApHCM and NSTEACS in 10 leads excluding leads aVF and V2. ApHCM was associated with a greater maximal amplitude of ST-segment depression in lead V5 (0.19±0.07 vs. 0.03±0.06, P=0.000). The number of leads with neg T waves also differed between ApHCM and NSTEACS (6.75±1.42 vs. 6.08±1.51, P=0.046). The sum of R wave in lead V5, neg T wave in lead V6 and ST-segment depression in lead V4>2.585 mV identified ApHCM with 90.2% sensibility and 87.5% specificity, representing the highest diagnostic accuracy.Conclusions: Compared with NSTEACS patients, ApHCM patients presented higher R waves and neg T wave voltage as well as a greater ST-segment depression in the 12-lead ECGs.

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Section: Aphcm Groupmentioning

confidence: 99%

Usefulness of ECG to differentiate apical hypertrophic cardiomyopathy from non-ST elevation acute coronary syndrome

Tao

Bako

et al. 2020

Preprint

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“…1 The apical subset is often defined as left ventricular predominating at the apex with a wall thickness ≥15 mm and a ratio of maximal apical to posterior wall thickness of ≥1.5 detected on echocardiography or cardiac MRI. 2 The apical left ventricular hypertrophy may cause large midventricular pressure gradients, confers an elevated risk of atrial fibrillation and is less associated with left ventricular outflow tract obstruction. 2 Apical HCM may be further complicated by aneurysm formation resulting in increased risk of thromboembolism, ventricular arrhythmia and sudden cardiac death.…”

Section: Images In…mentioning

confidence: 99%

“…2 The apical left ventricular hypertrophy may cause large midventricular pressure gradients, confers an elevated risk of atrial fibrillation and is less associated with left ventricular outflow tract obstruction. 2 Apical HCM may be further complicated by aneurysm formation resulting in increased risk of thromboembolism, ventricular arrhythmia and sudden cardiac death. 3 Patients suspected of HCM may be further investigated with cardiac MRI to assess the distribution and severity of left ventricular hypertrophy or aneurysm in a more sensitive manner compared with echocardiography.…”

Section: Images In…mentioning

confidence: 99%

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Left ventricular aneurysm complicating apical hypertrophic cardiomyopathy

et al. 2020

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“…Definition of ApHCM relies on demonstrating left ventricular hypertrophy predominating in the distal apex by cardiovascular magnetic resonance imaging or transthoracic echocardiography, with a wall thickness ≥ 15 mm of the apex and maximal apical/posterior wall ratio ≥ 1.5 [14,15].…”

Section: Aphcm Groupmentioning

confidence: 99%

Usefulness of ECG to differentiate apical hypertrophic cardiomyopathy from non-ST elevation acute coronary syndrome

Tao

Bako

et al. 2020

BMC Cardiovasc Disord

View full text Add to dashboard Cite

Background: Apical hypertrophic cardiomyopathy (ApHCM) is a phenotypic variant of nonobstructive HCM. ApHCM is characterized by left ventricular hypertrophy involve the distal apex. The electrocardiographic character of ApHCM can mimic non-ST elevation acute coronary syndrome (NSTEACS), triggering a series of studies and treatments that may be unnecessary. This study aimed to clarify the electrocardiogram (ECG) differences between the two diseases. Methods: Initial ECG recordings of 41 patients with ApHCM and 72 patients with NSTEACS were analyzed retrospectively. We analyzed the voltage of negative T (neg T) and R wave, the change of ST-segment as well as the number of leads with neg T wave in the 12-lead ECGs. Results: Across the 12-lead ECGs, the magnitude of R wave significantly differed between ApHCM and NSTEACS in 10 leads excluding leads aVR and V1. ApHCM was associated with a greater maximal amplitude of R wave in lead V5 (3.13 ± 1.08 vs. 1.38 ± 0.73 mV, P < 0.001). The magnitude of T wave significantly differed between ApHCM and NSTEACS in 10 leads excluding leads II and V1. ApHCM was associated with a greater maximal amplitude of neg T wave in lead V4 (0.85 ± 0.69 vs. 0.35 ± 0.23 mV, P < 0.001). The frequency of giant neg T (1mv or more) wave was higher in ApHCM (36.5% vs. 0%, P < 0.001). The magnitude of ST-segment deviation significantly differed between ApHCM and NSTEACS in 10 leads excluding leads aVF and V2. ApHCM was associated with a greater maximal amplitude of STsegment depression in lead V5 (0.19 ± 0.07 vs. 0.03 ± 0.06 mV, P < 0.001). The number of leads with neg T wave also differed between ApHCM and NSTEACS (6.75 ± 1.42 vs. 6.08 ± 1.51, P = 0.046). The sum of R wave in lead V5, neg T wave in lead V6 and ST-segment depression in lead V4 > 2.585 mV identified ApHCM with 90.2% sensibility and 87.5% specificity, representing the highest diagnostic accuracy. Conclusions: Compared with NSTEACS patients, ApHCM patients presented higher R and neg T wave voltage as well as a greater ST-segment depression in the 12-lead ECG. The ECG characteristics can help to differentiate ApHCM from NSTEACS in clinical setting.

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Apical Hypertrophic Cardiomyopathy: The Variant Less Known

Cited by 109 publications

References 48 publications

Usefulness of ECG to differentiate apical hypertrophic cardiomyopathy from non-ST elevation acute coronary syndrome

Usefulness of ECG to differentiate apical hypertrophic cardiomyopathy from non-ST elevation acute coronary syndrome

Left ventricular aneurysm complicating apical hypertrophic cardiomyopathy

Usefulness of ECG to differentiate apical hypertrophic cardiomyopathy from non-ST elevation acute coronary syndrome

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