Author + information
- Edward G. Abinader, MD∗ ()
- ↵∗Bnai Zion Medical Center, Medical Faculty, Technion Israel Institute of Technology, 26 Bet El Street, Haifa 34564, Israel
Rowin et al. (1) analyzed their experience in 93 hypertrophic cardiomyopathy (HCM) patients with left ventricular (LV) apical aneurysms (AA), which constituted 4.8% of their HCM population. Diagnosis was based on magnetic resonance imaging and echocardiography. Two distinct patterns of LV hypertrophy were identified, 51% were distal and 49% had hourglass configuration creating 2 distinct chambers, some with intraventricular gradients. Those with LV-AA had over 3-fold increase in HCM-related events, 5-fold more arrhythmias, and 2-fold increase in thromboembolic events. The investigators are commended on their detailed contribution that confirms the already known value of magnetic resonance imaging in the high-risk subgroup with LV-AA, which was effectively treated with contemporary means such as implantable defibrillators, ablations, and anticoagulation.
In 1982 we were among the first to report apical HCM outside Japan (2), and we revealed typical giant T-wave inversions, prominent precordial R waves, and spade-like LV configuration on angiography. Long-term 5- to 20-year follow-up (3) revealed changes such as attenuation of the typical electrocardiographic (ECG) changes, LV-AA with thrombus, ventricular tachycardias, atrial fibrillation, and implantation of a defibrillator. Thus contrary to prevailing concepts in 2002, we highlighted the fact that the natural history of the apical variant of HCM in Western countries outside Japan was not benign and mandates close long-term follow-up.
Often it is the ECG that prompts the clinician to look for the apical variant of HCM even in the presence of a normal echocardiogram. Moon et al. (4) from London share our view that the apical form is less benign outside Japan and highlights the fact that the ECG findings in the presence of a normal echocardiogram should prompt us to perform further imaging with magnetic resonance imaging or contrast echocardiography.
The complete exclusion of the ECG data and total absence of any discussion pertaining to this modality is notably lacking in this otherwise comprehensive and important study. A comparison of the ECG findings in their HCM patients with and without LV-AA and whether they noted any dynamic changes at follow-up would be most informative.
Please note: Dr. Abinader has reported that he has no relationships relevant to the contents of this paper to disclose.
- 2017 American College of Cardiology Foundation
- Rowin E.J.,
- Maron B.J.,
- Haas T.S.,
- et al.
- Moon J.C.,
- Fisher N.G.,
- McKenna W.J.,
- Pennell D.J.