Differential diagnosis of apical hypertrophic cardiomyopathy and apical displacement of the papillary muscles: a multimodality imaging point of view

Ünlü, Serkan; Tok, Özge Özden; Demir, Fulya Avcı; Papadopoulos, Konstantinos; Monaghan, Mark

doi:10.1111/echo.14895

Cited by 7 publications

(3 citation statements)

References 53 publications

(166 reference statements)

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“…Wall thickening confined to the LV apex is well described in humans but rarely recognized in cats, possibly because this area is more difficult to image and because papillary muscle hypertrophy is so common. 115 , 116 A frequent echocardiographic finding in a cat is a bulge at the base of the interventricular septum ( supplementary file 20 ). This bulge can be an isolated finding, with no other thickened areas of the LV, or can be seen in a cat with other regions of the LV that are also too thick.…”

Section: Diagnosismentioning

confidence: 99%

The Feline Cardiomyopathies: 2. Hypertrophic cardiomyopathy

Kittleson

Côté

2021

Journal of Feline Medicine and Surgery

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Practical relevance: Hypertrophic cardiomyopathy (HCM) is the most common form of feline cardiomyopathy observed clinically and may affect up to approximately 15% of the domestic cat population, primarily as a subclinical disease. Fortunately, severe HCM, leading to heart failure or arterial thromboembolism (ATE), only occurs in a small proportion of these cats. Patient group: Domestic cats of any age from 3 months upward, of either sex and of any breed, can be affected. A higher prevalence in male and domestic shorthair cats has been reported. Diagnostics: Subclinical feline HCM may or may not produce a heart murmur or gallop sound. Substantial left atrial enlargement can often be identified radiographically in cats with severe HCM. Biomarkers should not be relied on solely to diagnose the disease. While severe feline HCM can usually be diagnosed via echocardiography alone, feline HCM with mild to moderate left ventricular (LV) wall thickening is a diagnosis of exclusion, which means there is no definitive test for HCM in these cats and so other disorders that can cause mild to moderate LV wall thickening (eg, hyperthyroidism, systemic hypertension, acromegaly, dehydration) need to be ruled out. Key findings: While a genetic cause of HCM has been identified in two breeds and is suspected in another, for most cats the cause is unknown. Systolic anterior motion of the mitral valve (SAM) is the most common cause of dynamic left ventricular outflow tract obstruction (DLVOTO) and, in turn, the most common cause of a heart murmur with feline HCM. While severe DLVOTO is probably clinically significant and so should be treated, lesser degrees probably are not. Furthermore, since SAM can likely be induced in most cats with HCM, the distinction between HCM without obstruction and HCM with obstruction (HOCM) is of limited importance in cats. Diastolic dysfunction, and its consequences of abnormally increased atrial pressure leading to signs of heart failure, and sluggish atrial blood flow leading to ATE, is the primary abnormality that causes clinical signs and death in affected cats. Treatment (eg, loop diuretics) is aimed at controlling heart failure. Preventive treatment (eg, antithrombotic drugs) is aimed at reducing the risk of complications (eg, ATE). Conclusions: Most cats with HCM show no overt clinical signs and live a normal or near-normal life despite this disease. However, a substantial minority of cats develop overt clinical signs referable to heart failure or ATE that require treatment. For most cats with clinical signs caused by HCM, the long-term prognosis is poor to grave despite therapy. Areas of uncertainty: Genetic mutations (variants) that cause HCM have been identified in a few breeds, but, despite valiant efforts, the cause of HCM in the vast majority of cats remains unknown. No treatment currently exists that reverses or even slows the cardiomyopathic process in HCM, again despite valiant efforts. The search goes on.

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Section: Diagnosismentioning

confidence: 99%

The Feline Cardiomyopathies: 2. Hypertrophic cardiomyopathy

Kittleson

Côté

2021

Journal of Feline Medicine and Surgery

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“…In apical HCM complicated by left ventricular outflow obstruction, auscultation may reveal a crescendo-decrescendo systolic murmur in the left sternal border due to turbulence within the LV and mitral incompetence. Therefore, careful multimodality imaging is important to differentiate the two [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

A Novel Case of Yamaguchi Syndrome in a Hispanic Male

Shah

Fujikawa

Miller

et al. 2021

Cureus

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Yamaguchi syndrome or apical hypertrophic cardiomyopathy (HCM) is a unique variant of HCM. It is characterized by localized hypertrophy involving the left ventricular apex rather than the left ventricular septum. This syndrome has been traditionally seen in the Asian population, particularly those of Japanese descent. We present an interesting case of Yamaguchi syndrome seen in a Hispanic male.A 48-year-old Hispanic male presented with epigastric tenderness and was admitted to the hospital for a non-ST-segment elevation myocardial infarction. His diagnostic catheterization revealed no significant coronary artery disease. However, his echocardiogram revealed apical hypertrophy and narrowing of the left ventricular cavity at the apex, consistent with Yamaguchi syndrome. Case reports such as ours serve to help clinicians broaden their differential diagnoses when approaching patients with acute coronary syndromelike symptoms to include diagnoses such as Yamaguchi syndrome.

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“…Apical sparing is commonly observed in patients with cardiac amyloidosis, whereas longitudinal dysfunction of the septum may indicate asymmetric septal hypertrophic cardiomyopathy. [ 34 , 36 , 37 ]…”

Section: Strain Imaging In Hfpefmentioning

confidence: 99%

Imaging in Heart Failure with Preserved Ejection Fraction: A Multimodality Imaging Point of View

2023

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Heart failure with preserved ejection fraction (HFpEF) is an important global health problem. Despite increased prevalence due to improved diagnostic options, limited improvement has been achieved in cardiac outcomes. HFpEF is an extremely complex syndrome and multimodality imaging is important for diagnosis, identifying its different phenotypes and determining prognosis. Evaluation of left ventricular filling pressures using echocardiographic diastolic function parameters is the first step of imaging in clinical practice. The role of echocardiography is becoming more popular and with the recent developments in deformation imaging, cardiac MRI is extremely important as it can provide tissue characterisation, identify fibrosis and optimal volume measurements of cardiac chambers. Nuclear imaging methods can also be used in the diagnosis of specific diseases, such as cardiac amyloidosis.

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Differential diagnosis of apical hypertrophic cardiomyopathy and apical displacement of the papillary muscles: a multimodality imaging point of view

Cited by 7 publications

References 53 publications

The Feline Cardiomyopathies: 2. Hypertrophic cardiomyopathy

The Feline Cardiomyopathies: 2. Hypertrophic cardiomyopathy

A Novel Case of Yamaguchi Syndrome in a Hispanic Male

Imaging in Heart Failure with Preserved Ejection Fraction: A Multimodality Imaging Point of View

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