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High-risk imaging characteristics in left ventricular apex for the life-threatening arrhythmic events in Japanese hypertrophic cardiomyopathy patients

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Abstract

Left ventricular (LV) apical aneurysm is known to be associated with the life-threatening arrhythmic events in hypertrophic cardiomyopathy (HCM). However, the current 2014 ESC guideline has not included apical aneurysm as a major risk factor for sudden cardiac death and 2018 JCS guideline includes it only as a modulator, while it has been included as a new major risk marker in 2020 AHA/ACC guideline. Therefore, we sought to identify high-risk imaging characteristics in LV apex which is associated with a higher occurrence of ventricular tachycardia/fibrillation (VT/VF). In 99 consecutive Japanese HCM patients (median age, 65 years; 59 males) undergoing implantable cardioverter-defibrillator (ICD) implantation for primary prevention following cardiac magnetic resonance including late gadolinium enhancement (LGE), the occurrence of appropriate ICD interventions for VT/VF was evaluated for 6.2 (median) years after ICD implantation. Overall, appropriate ICD interventions occurred in 43% with annual rates of 7.0% for appropriate interventions. Kaplan–Meier analysis demonstrated that the presence of LV apical aneurysm was significantly associated with a higher occurrence of appropriate interventions (annual rates 18.9% vs. 6.4%, P = 0.013). Similarly, patients with high LV mid-to-apex pressure gradient (annual rates 14.9% vs. 6.2%, P = 0.022) and presence of apical LGE (annual rates 10.9% vs. 4.0%, P = 0.001) experienced appropriate interventions more frequently. An aneurysm, high-pressure gradient, and LGE in an apex are associated with VT/VF. These characteristics in apex should be kept in mind when implanting ICD in Japanese HCM patients as a primary prevention.

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Data availability 

The data that support the findings of this study are available from the corresponding author, [author initials], upon reasonable request.

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Acknowledgements

This study was supported by the Sakakibara Clinical Research Grant for Promotion of Science, 2022. We thank Mr Naokazu Mizuno, Mr Jun Matsuda of the staff at Sakakibara Heart Institute for technical assistance

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Authors and Affiliations

  1. Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahi-Cho, Fuchu-City, Tokyo, 183-0003, Japan

    Yasuki Hen, Nobuo Iguchi, Ayako Takara, Kanki Inoue, Itaru Takamisawa & Morimasa Takayama

  2. Department of Radiology, Sakakibara Heart Institute, 3-16-1 Asahi-Cho, Fuchu-City, Tokyo, 183-0003, Japan

    Yuka Otaki, Kaori Takada & Mitsuru Kanisawa

  3. Department of Radiology, Tokyo Women’s Medical University Adachi Medical Center, Tokyo, Japan

    Haruhiko Machida

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  1. Yasuki Hen
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Hen, Y., Otaki, Y., Iguchi, N. et al. High-risk imaging characteristics in left ventricular apex for the life-threatening arrhythmic events in Japanese hypertrophic cardiomyopathy patients. Heart Vessels 38, 1442–1450 (2023). https://doi.org/10.1007/s00380-023-02295-0

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