Abstract
Apical variant hypertrophic cardiomyopathy (AHCM) is characterized by asymmetric hypertrophy of the left ventricular (LV) apex. T wave inversions of variable degree, particularly in the left precordial leads, and left ventricular hypertrophy (LVH) are common EKG findings in AHCM. Echocardiography is typically the initial imaging modality used in the diagnosis and evaluation of AHCM. The diagnosis is made when the LV apex has apical wall thickness of ≥ 15 mm or a ratio of apical to basal LV wall thickness of ≥ 1.3 at end-diastole. The use of microbubble contrast agents with echocardiography is helpful for visualization of the apex. Cardiac magnetic resonance (CMR) has the advantage of a large field of view and the ability to perform tissue characterization. Late gadolinium enhancement (LGE) sequences are essential in the assessment of potential areas of myocardial scarring. Cardiac computed tomography (CCT) has the advantage of being able to evaluate coronary arteries in addition to assessing cardiac anatomy and function. A “Solar Polar” map pattern is the characteristic feature of AHCM on myocardial perfusion imaging (MPI) in cases not associated with apical aneurysm (APA). Recognition of typical perfusion patterns in AHCM patients is not only important in the diagnostic evaluation of this disease process, but also for avoiding unnecessary and costly tests. The purpose of this article is to review the imaging features of AHCM from different imaging modalities and assess the value added of each modality in the diagnosis of AHCM.
Similar content being viewed by others
References
Eriksson MJ et al (2002) Long-term outcome in patients with apical hypertrophic cardiomyopathy. J Am Coll Cardiol 39(4):638–645
Ho HH et al (2004) Clinical characteristics of and long-term outcome in Chinese patients with hypertrophic cardiomyopathy. Am J Med 116(1):19–23
Kitaoka H et al (2003) Comparison of prevalence of apical hypertrophic cardiomyopathy in Japan and the United States. Am J Cardiol 92(10):1183–1186
Moon JC et al (2004) Detection of apical hypertrophic cardiomyopathy by cardiovascular magnetic resonance in patients with non-diagnostic echocardiography. Heart 90(6):645–649
Jan MF et al (2016) Apical hypertrophic cardiomyopathy: present status. Int J Cardiol 222:745–759
Cerqueira MD et al (2002) Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation 105(4):539–542
Kim EK et al (2016) Differences in apical and non-apical types of hypertrophic cardiomyopathy: a prospective analysis of clinical, echocardiographic, and cardiac magnetic resonance findings and outcome from 350 patients. Eur Heart J Cardiovasc Imaging 17(6):678–686
Gersh BJ et al (2011) ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Developed in collaboration with the American Association for Thoracic Surgery, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2011. 58(25):e212–e260
Choi EY et al (2008) Phenotypic spectrum and clinical characteristics of apical hypertrophic cardiomyopathy: multicenter echo-Doppler study. Cardiology 110(1):53–61
Di Tullio MR et al (1999) Left atrial size and the risk of ischemic stroke in an ethnically mixed population. Stroke 30(10):2019–2024
Takemoto Y et al (2005) Usefulness of left atrial volume in predicting first congestive heart failure in patients > or = 65 years of age with well-preserved left ventricular systolic function. Am J Cardiol 96(6):832–836
Lang RM et al (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 28(1):1-39.e14
Yang H et al (2005) Enlarged left atrial volume in hypertrophic cardiomyopathy: a marker for disease severity. J Am Soc Echocardiogr 18(10):1074–1082
Spirito P et al (2000) Magnitude of left ventricular hypertrophy and risk of sudden death in hypertrophic cardiomyopathy. N Engl J Med 342(24):1778–1785
Biswas M et al (2013) Two- and three-dimensional speckle tracking echocardiography: clinical applications and future directions. Echocardiography 30(1):88–105
Chang SA et al (2010) Left ventricular twist mechanics in patients with apical hypertrophic cardiomyopathy: assessment with 2D speckle tracking echocardiography. Heart 96(1):49–55
Saccheri MC et al (2017) Speckle tracking echocardiography to assess regional ventricular function in patients with apical hypertrophic cardiomyopathy. World J Cardiol 9(4):363–370
Binder J et al (2011) Apical hypertrophic cardiomyopathy: prevalence and correlates of apical outpouching. J Am Soc Echocardiogr 24(7):775–781
Rowin EJ et al (2017) Hypertrophic cardiomyopathy with left ventricular apical aneurysm: implications for risk stratification and management. J Am Coll Cardiol 69(7):761–773
Matsubara K et al (2003) Sustained cavity obliteration and apical aneurysm formation in apical hypertrophic cardiomyopathy. J Am Coll Cardiol 42(2):288–295
Kim H et al (2016) Significance of apical cavity obliteration in apical hypertrophic cardiomyopathy. Heart 102(15):1215–1220
Minami Y, Haruki S, Hagiwara N (2014) Phenotypic overlap in hypertrophic cardiomyopathy: apical hypertrophy, midventricular obstruction, and apical aneurysm. J Cardiol 64(6):463–469
Maron MS et al (2008) Prevalence, clinical significance, and natural history of left ventricular apical aneurysms in hypertrophic cardiomyopathy. Circulation 118(15):1541–1549
Nagueh SF et al (2011) American Society of Echocardiography clinical recommendations for multimodality cardiovascular imaging of patients with hypertrophic cardiomyopathy: endorsed by the American Society of Nuclear Cardiology, Society for Cardiovascular Magnetic Resonance, and Society of Cardiovascular Computed Tomography. J Am Soc Echocardiogr 24(5):473–498
Parato VM et al (2016) Echocardiographic diagnosis of the different phenotypes of hypertrophic cardiomyopathy. Cardiovasc Ultrasound 14(1):30
Geske JB et al (2007) Evaluation of left ventricular filling pressures by Doppler echocardiography in patients with hypertrophic cardiomyopathy: correlation with direct left atrial pressure measurement at cardiac catheterization. Circulation 116(23):2702–2708
Nishimura RA et al (1996) Noninvasive doppler echocardiographic evaluation of left ventricular filling pressures in patients with cardiomyopathies: a simultaneous Doppler echocardiographic and cardiac catheterization study. J Am Coll Cardiol 28(5):1226–1233
Kitaoka H et al (2013) Tissue Doppler imaging and prognosis in asymptomatic or mildly symptomatic patients with hypertrophic cardiomyopathy. Eur Heart J Cardiovasc Imaging 14(6):544–549
Kitaoka H et al (2011) Tissue doppler imaging and plasma BNP levels to assess the prognosis in patients with hypertrophic cardiomyopathy. J Am Soc Echocardiogr 24(9):1020–1025
Nagueh SF et al (1999) Doppler estimation of left ventricular filling pressures in patients with hypertrophic cardiomyopathy. Circulation 99(2):254–261
Nagueh SF et al (2016) Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 29(4):277–314
Nakamura T et al (1992) Diastolic paradoxic jet flow in patients with hypertrophic cardiomyopathy: evidence of concealed apical asynergy with cavity obliteration. J Am Coll Cardiol 19(3):516–524
Mulvagh SL et al (2008) American Society of Echocardiography consensus statement on the clinical applications of ultrasonic contrast agents in echocardiography. J Am Soc Echocardiogr 21(11):1179–201 (quiz 1281)
Minami Y et al (2011) Clinical implications of midventricular obstruction in patients with hypertrophic cardiomyopathy. J Am Coll Cardiol 57(23):2346–2355
Prasad K et al (1999) Echocardiographic pitfalls in the diagnosis of hypertrophic cardiomyopathy. Heart 82:Iii8–Iii15
Amano Y et al (2018) Cardiac MR imaging of hypertrophic cardiomyopathy: techniques, findings, and clinical relevance. Magn Reson Med Sci 17(2):120–131
Parisi R et al (2014) Multimodality imaging in apical hypertrophic cardiomyopathy. World J Cardiol 6(9):916–923
Baxi AJ et al (2016) Hypertrophic cardiomyopathy from A to Z: genetics, pathophysiology, imaging, and management. Radiographics 36(2):335–354
Yamada M et al (2009) Frequency and distribution of late gadolinium enhancement in magnetic resonance imaging of patients with apical hypertrophic cardiomyopathy and patients with asymmetrical hypertrophic cardiomyopathy: a comparative study. Int J Cardiovasc Imaging 25(Suppl 1):131–138
Olivotto I et al (2012) Patterns of disease progression in hypertrophic cardiomyopathy: an individualized approach to clinical staging. Circ Heart Fail 5(4):535–546
Morishita S et al (2001) Impaired retention of technetium-99m tetrofosmin in hypertrophic cardiomyopathy. Am J Cardiol 87(6):743–747
Ward RP et al (2003) Resting "Solar Polar" map pattern and reduced apical flow reserve: characteristics of apical hypertrophic cardiomyopathy on SPECT myocardial perfusion imaging. J Nucl Cardiol 10(5):506–512
Cianciulli TF et al (2009) Myocardial perfusion SPECT in the diagnosis of apical hypertrophic cardiomyopathy. J Nucl Cardiol 16(3):391–395
Zhou Y et al (2019) Development and validation of a new method to diagnose apical hypertrophic cardiomyopathy by gated single-photon emission computed tomography myocardial perfusion imaging. Nucl Med Commun 40(3):206–211
Yamamoto H et al (2017) Occasionally increased (18)F-fluorodeoxyglucose uptake in apical hypertrophic cardiomyopathy with mid-ventricular obstruction. J Cardiol Cases 16(2):44–47
Norikane T et al (2019) Occasionally increased (18)F-FDG uptake in apical hypertrophic cardiomyopathy on serial follow-up PET/CT. J Nucl Cardiol. https://doi.org/10.1007/s12350-019-01623-0
Takeishi Y et al (2017) Cardiac imaging with (18)F-fluorodeoxyglucose PET/MRI in hypertrophic cardiomyopathy. J Nucl Cardiol 24(5):1827–1828
Akbulut A et al (2019) The detection of apical variant of hypertrophic cardiomyopathy in myocardial perfusion imaging. Acta Cardiol 74:1–3
Zein RK et al (2017) An uncommon variant of an uncommon disease: a Caucasian adolescent with apical hypertrophic cardiomyopathy diagnosed with myocardial perfusion imaging. World J Nucl Med 16(3):251–254
Masrur S et al (2016) SPECT myocardial perfusion imaging in the diagnosis of apical hypertrophic cardiomyopathy. Tex Heart Inst J 43(5):467–468
Jouni H, Geske JB, Miller TD (2013) The diagnosis of apical hypertrophic cardiomyopathy with myocardial perfusion imaging. Heart 99(14):1064–1065
Hsieh BP, Travin MI (2012) Myocardial perfusion image findings in apical hypertrophic cardiomyopathy. J Nucl Cardiol 19(1):172–176
Russo RR et al (2010) Severe ischaemia on SPECT myocardial perfusion imaging secondary to microvascular dysfunction and apical hypertrophic cardiomyopathy. Clin Nucl Med 35(12):937–940
Irwin RB, Arumugam P, Khattar RS (2010) Incidental detection of apical hypertrophic cardiomyopathy by myocardial perfusion imaging. Nucl Med Commun 31(4):286–293
Minamimoto R et al (2013) Incidental focal FDG uptake in heart is a lighthouse for considering cardiac screening. Ann Nucl Med 27(6):572–580
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors have no conflicts of interests or financial relations to disclose. The manuscript does not contain clinical studies or patient’s data. The authors comply with international, national and institutional ethical standards.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Huang, G., Fadl, S.A., Sukhotski, S. et al. Apical variant hypertrophic cardiomyopathy “multimodality imaging evaluation”. Int J Cardiovasc Imaging 36, 553–561 (2020). https://doi.org/10.1007/s10554-019-01739-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10554-019-01739-x