What is the clinical evidence from this study?

Study design: Observational. Population: Apical hypertrophic cardiomyopathy (n=7). Intervention: Clinical and metabolic evaluation. Primary outcome: Clinical, echocardiographic, and metabolic characteristics.

November 2, 1983

Apical hypertrophic cardiomyopathy: clinical and metabolic studies

Key Result

Clinical and metabolic evaluation of patients with apical hypertrophic cardiomyopathy revealed apical thickness of 17.2 mm and progression to diffuse hypertrophy over 43 months.

Study Design

Type

Observational (n=7)

Structured PICO

Population

7 patients (5 men, 2 women) with concentric apical hypertrophy (hypertrophic non-obstructive cardiomyopathy) who underwent heart catheterization due to giant negative T waves in the precordial leads.

Intervention

Clinical, echocardiographic, angiographic, and metabolic evaluation (including atrial pacing with coronary arterial and venous lactate sampling).

Outcome

Echocardiographic, angiographic, and metabolic characteristics, and clinical/echocardiographic progression over follow-up.

Apical hypertrophic cardiomyopathy is characterized by a spade-like ventriculogram, metabolic abnormalities, and potential progression to concentric diffuse hypertrophy over time.

Abstract

Among the hypertrophic non-obstructive cardiomyopathies, a particular group of patients with concentric apical hypertrophy can be described. We studied seven patients (five men and two women) who underwent heart catheterization because they had giant negative T waves in the precordial leads. M-mode and two-dimensional echocardiograms revealed no obstruction within the outflow tract of the ventricle. Coronary angiography was normal in all cases. None of these patients demonstrated any significant peak systolic pressure gradient in the outflow tract. A characteristic spade-like configuration (concentric apical hypertrophy) was observed in the right anterior oblique ventriculogram at end diastole. The apical thickness reached 17.2 +/- 0.85 mm and was significantly greater than mid-anterior wall thickness (9.8 +/- 2.14 mm). In five cases, atrial pacing with coronary arterial and venous lactate sampling revealed abnormalities in myocardial metabolism. With a mean follow up of 43 months, three patients remain asymptomatic and one had heart failure. ECG abnormalities were unchanged and echocardiograms showed an increase of the septal and posterior wall thickness, suggesting a transformation in concentric diffuse hypertrophic cardiomyopathy.

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