April 21, 2026Journal of the American College of Cardiology
Hypertrophic Cardiomyopathy With Left Ventricular Apical Aneurysm
Key result
LV apical aneurysms linked to ~3-fold higher rate of HCM-related death or aborted events.
- 3-fold greater
- P<0.001
- n=1,940
Why the study?
Patients with hypertrophic cardiomyopathy and left ventricular apical aneurysms are increasingly recognized, but risks associated with this subgroup were unknown.
Does the presence of a left ventricular apical aneurysm increase the risk of adverse clinical events in patients with hypertrophic cardiomyopathy?
Key Points
- Clarify the clinical course and prognosis of HCM patients with left ventricular apical aneurysms over long-term follow-up.
- Retrospective analysis of 1,940 HCM patients from 2 centers, identifying 93 with LV apical aneurysms.
- Mean age was 56 ± 13 years; 69% were male.
- Follow-up duration averaged 4.4 ± 3.2 years.
- 3% of patients with LV apical aneurysms died suddenly or from heart failure.
- 24% survived with contemporary treatments, including 18 patients receiving ICD discharges.
- HCM-related deaths and life-saving events occurred at a rate of 6.4%/year, significantly higher than 2.0%/year in HCM patients without aneurysms (p < 0.001).
Study Design
Type
Cohort (n=1,940)
Multicenter
Yes
Structured PICO
Does the presence of a left ventricular apical aneurysm increase the risk of adverse clinical events in patients with hypertrophic cardiomyopathy?
P
Population
1,940 consecutive hypertrophic cardiomyopathy (HCM) patients, including 93 with LV apical aneurysms (mean age 56 ± 13 years, 69% male) and 1,847 without aneurysms.
C
Comparator
1,847 HCM patients without LV apical aneurysms
O
Outcome
Rate of HCM-related deaths combined with life-saving aborted disease-related eventshard clinical
Main Result
Effect estimate: 3-fold greater
Absolute Event Rate: 6.4% vs 2%
p-value: p=< 0.001
HCM patients with LV apical aneurysms represent a high-risk phenotype with a 3-fold greater rate of HCM-related deaths and life-saving aborted events compared to those without aneurysms.
Discussion
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Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
MKMihelle KittlesonDirector of postgraduate education, Cedars-Sinai
“What has been bumped up in importance is an ejection fraction (EF) less than 50%, the presence of an LV apical aneurysm, and the presence of extensive gadolinium enhancement, which also emphasizes the increased importance given to the role of MRI in risk stratification.”
“If there is progressive scar formation in the apex region, this can lead to an apical aneurysm and ventricular arrhythmias over time.”
MDMilind DesaiDirector, HCM Center, Cleveland Clinic
“We also created an apical HCM risk score, which uses age, apical aneurysm, left atrial volume index, serum creatinine and right ventricular systolic pressure to help predict the likelihood of adverse events in this population.”
Implication
Identifies LV apical aneurysm as high-risk HCM marker warranting vigilance; leaves open optimal surveillance and prevention strategies pending prospective validation.
Cite This Study
Rowin et al. (2017) conducted a cohort in Hypertrophic Cardiomyopathy (n=1,940). Left ventricular apical aneurysm vs. HCM patients without aneurysms was evaluated on HCM-related deaths combined with life-saving aborted disease-related events (3-fold greater, p=< 0.001). Hypertrophic cardiomyopathy patients with left ventricular apical aneurysms had a significantly higher rate of HCM-related deaths and life-saving aborted events than those without (6.4%/year vs 2.0%/year; p<0.001).