Skip to main content

Advertisement

SpringerLink
Log in

Clinical, echocardiographic and cardiac MRI predictors of outcomes in patients with apical hypertrophic cardiomyopathy

  • Original Paper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

Recent studies have found that some adverse cardiovascular events could also occur in patients with apical hypertrophic cardiomyopathy (ApHCM), which is different with previous studies suggesting benign nature of this condition. Therefore, the present study aimed to observe the clinical prognosis of ApHCM and to identify the predictors of poor prognosis in clinical, echocardiography and cardiac magnetic resonance (CMR). A total of 126 ApHCM patients with both echocardiography and CMR were identified retrospectively from January 2008 to December 2018. Adverse clinical events were defined as a composite of cardiac death, progressive heart failure, myocardial infarction, thromboembolic stroke, appropriate implantable cardioverter-defibrillator (ICD) interventions for ventricular tachycardia or ventricular fibrillation, and new-onset atrial fibrillation (AF). During a mean follow-up of 96.8 ± 36.0 months, clinical events were observed in 34 (27.0%) patients. As compared with patients without clinical events, patients with clinical events were older and had a higher incidence of heart failure. Moreover, patients with clinical events had a higher incidence of non-sustained ventricular tachycardia (NSVT) and had larger left atrial volume index (LAVI), thicker apical thickness, lower peak systolic mitral annular velocity (S′) than those without clinical events. In addition, late gadolinium enhancement (LGE) in CMR were more frequently observed in patients with clinical events. Five predictors of poor prognosis were identified: age ≥ 55 years, LAVI ≥ 36.7 ml/m2, S′ ≤ 6.7 cm/s, NSVT and LGE. ApHCM was not as benign as expected. Age ≥ 55 years, LAVI ≥ 36.7 ml/m2, S′ ≤ 6.7 cm/s along with NSVT and LGE were independent predictors for poor prognosis of ApHCM.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data availability

None.

Abbreviations

AF:

Atrial fibrillation

ApHCM:

Apical hypertrophic cardiomyopathy

CMR:

Cardiac magnetic resonance

ECG:

Electrocardiogram

HCM:

Hypertrophic cardiomyopathy

ICD:

Implantable cardioverter-defibrillator

LA:

Left atrium

LAVI:

Left atrial volume index

LGE:

Late gadolinium enhancement

LV:

Left ventricle

LVAA:

Left ventricle apical aneurysm

NSVT:

Non-sustained ventricular tachycardia

SCD:

Sudden cardiac death

References

  1. Maron BJ, Maron MS (2013) Hypertrophic cardiomyopathy. Lancet 381(9862):242–255

    Article  Google Scholar 

  2. Eriksson MJ, Sonnenberg B, Woo A, Rakowski P, Parker TG, Wigle D et al (2002) Long-term outcome in patients with apical hypertrophic cardiomyopathy. J Am Coll Cardiol 40(4):837–838

    Article  Google Scholar 

  3. Klarich KW, Attenhofer Jost CH, Binder J, Connolly HM, Scott CG, Freeman WK et al (2013) Risk of death in long-term follow-up of patients with apical hypertrophic cardiomyopathy. Am J Cardiol 111(12):1784–1791

    Article  Google Scholar 

  4. Sakamoto T, Tei C, Murayama M, Ichiyasu H, Hada Y (1976) Giant T wave inversion as a manifestation of asymmetrical apical hypertrophy (AAH) of the left ventricle. Echocardiographic and ultrasono-cardiotomographic study. Jpn Heart J 17(5):611–629

    Article  CAS  Google Scholar 

  5. Moro E, D’Angelo G, Nicolosi G, Mimo R, Zanuttini D (1995) Long-term evaluation of patients with apical hypertrophic cardiomyopathy. Correlation between quantitative echocardiographic assessment ofapical hypertrophy and clinical-electrocardiographic findings. Eur Heart J 16(2):210–217

    Article  CAS  Google Scholar 

  6. Sakamoto T, Amano K, Hada Y, Tei C, Takenaka K, Hasegawa I et al (1986) Asymmetric apical hypertrophy ten years experience. Postgrad Med J. https://doi.org/10.1136/pgmj.62.728.567

    Article  PubMed  PubMed Central  Google Scholar 

  7. Moon J, Shim CY, Ha JW, Cho IJ, Kang MK, Yang WI et al (2011) Clinical and echocardiographic predictors of outcomes in patients with apical hypertrophic cardiomyopathy. Am J Cardiol 108(11):1614–1619

    Article  Google Scholar 

  8. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA et al (2005) Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 18(12):1440–1463

    Article  Google Scholar 

  9. Spirito P, Seidman CE, McKenna WJ, Maron BJ (1997) The management of hypertrophic cardiomyopathy. N Engl J Med 336(11):775–785

    Article  CAS  Google Scholar 

  10. Maron MS, Finley JJ, Bos JM, Hauser TH, Manning WJ, Haas TS et al (2008) Prevalence, clinical significance, and natural history of left ventricular apical aneurysms in hypertrophic cardiomyopathy. Circulation 118(15):1541–1549

    Article  Google Scholar 

  11. Kim H, Park JH, Won KB, Yoon HJ, Park HS, Cho YK et al (2016) Significance of apical cavity obliteration in apical hypertrophic cardiomyopathy. Heart 102(15):1215–1220

    Article  Google Scholar 

  12. Weissler-Snir A, Allan K, Cunningham K, Connelly KA, Lee DS, Spears DA et al (2019) Hypertrophic cardiomyopathy-related sudden cardiac death in young people in Ontario. Circulation 140(21):1706–1716

    Article  Google Scholar 

  13. Pritchett AM, Mahoney DW, Jacobsen SJ, Rodeheffer RJ, Karon BL, Redfield MM (2005) Diastolic dysfunction and left atrial volume: a population-based study. J Am Coll Cardiol 45(1):87–92

    Article  Google Scholar 

  14. Benjamin EJ, D’Agostino RB, Belanger AJ, Wolf PA, Levy D (1995) Left atrial size and the risk of stroke and death. The Framingham Heart Study. Circulation 92(4):835–841

    Article  CAS  Google Scholar 

  15. Rossi A, Tomaino M, Golia G, Santini F, Pentiricci S, Marino P, Zardini P (2000) Usefulness of left atrial size in predicting postoperative symptomatic improvement in patients with aortic stenosis. Am J Cardiol 86(5):567–570

    Article  CAS  Google Scholar 

  16. Moller JE, Hillis GS, Oh JK, Seward JB, Reeder GS, Wright RS et al (2003) Left atrial volume: a powerful predictor of survival after acute myocardial infarction. Circulation 107(17):2207–2212

    Article  Google Scholar 

  17. Yang WI, Shim CY, Kim YJ, Kim SA, Rhee SJ, Choi EY et al (2009) Left atrial volume index: a predictor of adverse outcome in patients with hypertrophic cardiomyopathy. J Am Soc Echocardiogr 22(12):1338–1343

    Article  Google Scholar 

  18. Monserrat L, Elliott PM, Gimeno JR, Sharma S, Penas-Lado M, McKenna WJ (2003) Non-sustained ventricular tachycardia in hypertrophic cardiomyopathy. J Am Coll Cardiol 42(5):873–879

    Article  Google Scholar 

  19. O’Mahony C, Jichi F, Pavlou M, Monserrat L, Anastasakis A, Rapezzi C et al (2014) A novel clinical risk prediction model for sudden cardiac death in hypertrophic cardiomyopathy (HCM risk-SCD). Eur Heart J 35(30):2010–2020

    Article  Google Scholar 

  20. Fattori R, Biagini E, Lorenzini M, Buttazzi K, Lovato L, Rapezzi C (2010) Significance of magnetic resonance imaging in apical hypertrophic cardiomyopathy. Am J Cardiol 105(11):1592–1596

    Article  Google Scholar 

  21. Quarta G, Aquaro GD, Pedrotti P, Pontone G, Dellegrottaglie S, Iacovoni A et al (2018) Cardiovascular magnetic resonance imaging in hypertrophic cardiomyopathy: the importance of clinical context. Eur Heart J Cardiovasc Imaging 19(6):601–610

    Article  Google Scholar 

  22. Jan MF, Todaro MC, Oreto L, Tajik AJ (2016) Apical hypertrophic cardiomyopathy: present status. Int J Cardiol 222:745–759

    Article  Google Scholar 

  23. Chan RH, Maron BJ, Olivotto I, Pencina MJ, Assenza GE, Haas T et al (2014) Prognostic value of quantitative contrast-enhanced cardiovascular magnetic resonance for the evaluation of sudden death risk in patients with hypertrophic cardiomyopathy. Circulation 130(6):484–495

    Article  Google Scholar 

  24. Yang K, Song YY, Chen XY, Wang JX, Li L, Yin G et al (2020) Apical hypertrophic cardiomyopathy with left ventricular apical aneurysm: prevalence, cardiac magnetic resonance characteristics, and prognosis. Eur Heart J Cardiovasc Imaging 21(12):1341–1350

    Article  Google Scholar 

Download references

Acknowledgements

The authors sincerely thank all colleagues and patients participated in this study.

Funding

None.

Author information

Authors and Affiliations

  1. Department of Cardiology, Affiliated Wuxi No.2 Hospital, Nanjing Medical University, Wuxi, 214002, Jiangsu, China

    Yanwei Yin, Wenjing Hu, Lishu Zhang, Dan Wu, Chengjiang Yang & Xinhe Ye

Authors
  1. Yanwei Yin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wenjing Hu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lishu Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dan Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Chengjiang Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Xinhe Ye
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

YY: substantial contribution to the conception and design of research, data acquisition, statistical analysis and manuscript drafting; WH, LZ, DW: substantial contribution to the data acquisition; CY, XY: substantial contribution to the design of research and critical manuscript revision.

Corresponding author

Correspondence to Xinhe Ye.

Ethics declarations

Conflict of interest

All authors declared no conflict of interest.

Ethical approval

The study was approved by the institutional review boards and all subjects provided informed consent.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 23 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yin, Y., Hu, W., Zhang, L. et al. Clinical, echocardiographic and cardiac MRI predictors of outcomes in patients with apical hypertrophic cardiomyopathy. Int J Cardiovasc Imaging 38, 643–651 (2022). https://doi.org/10.1007/s10554-021-02430-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-021-02430-w

Keywords

Search

Navigation