The prevalence, clinical, and morphological characteristics of cases with apical hypertrophic cardiomyopathy diagnosed in a training hospital of a medical faculty

OBJECTIVES
We evaluated the relative frequency and clinical and morphological features of apical hypertrophic cardiomyopathy (HCM) among patients diagnosed as having HCM in our hospital in the last 13 years.
STUDY DESIGN
Among 193 patients whose diagnoses of HCM were made between 1991 and 2004, we reviewed clinical, demographic, electrocardiographic, echocardiographic, and angiographic data of 11 patients (5.7%; 3 males, 8 females; mean age 56 years; range 41 to 70 years) who were found to have apical HCM.
RESULTS
The most frequent electrocardiographic finding in patients with apical HCM was giant negative T waves more than 10 mm in depth in the precordial leads (7 patients, 63.6%) followed by voltage criteria for left ventricular hypertrophy (6 patients, 54.6%). Echocardiographic examination showed left ventricular apical wall thickness of greater than 15 mm below the papillary muscles in all the patients, and mild mitral (n=2), aortic (n=2), and tricuspid (n=2) valve insufficiencies. Most importantly, the typical “ace of spades" configuration of the left ventricle at end-diastole was observed in all the patients during contrast ventriculography. On coronary angiography, three patients had two-vessel disease, coronary ectasia, and myocardial muscular bridge in the middle segment of the left anterior descending artery, respectively. One patient had microfistulae between the left anterior descending artery and the left ventricle.
CONCLUSION
Although it is difficult to generalize for the overall population, apical HCM seems to be more frequent in our patient population compared to that of western countries, with clinical, morphological, electrocardiographic, and ventriculographic findings similar to the Japanese type.