Presence of Apical Aneurysm and Its Impact on Left Ventricular Mechanics and Mechano‐Energetic Coupling in Patients With Apical Hypertrophic Cardiomyopathy

Background Left ventricular (LV) apical aneurysms (ApAn+) occur in 10%–15% of apical hypertrophic cardiomyopathy (ApHCM) patients and confer considerable morbidity. We hypothesized that ApAn+ adversely impact ventricular mechanics and mechano‐energetic coupling in ApHCM. Methods Ninety‐eight ApHCM patients were identified, of which nine (9%) had ApAn+ and were compared with 89 (91%) who did not (ApAn−). 2D speckle‐tracking echocardiography assessed ventricular mechanics using LV global longitudinal strain (GLS) and torsion, and mechano‐energetic coupling as myocardial work indices. Clinical events over follow‐up were adjudicated. Results Mean age was 64 ± 15 years, 46% were female, and 3% had an HCM family history, with similar clinical risk factors between groups. Of the nine ApAn+ patients, there were six small (<2 cm) and three moderate‐sized (2‐4 cm) aneurysms. There was no difference in LV ejection fraction (65 ± 15 vs. 67 ± 11%, p = 0.51) or GLS (−9.6 ± 3.3 vs. −11.9 ± 3.9%, p = 0.09) between ApAn+ versus ApAn−. ApAn+ patients had greater myocardial global wasted work (347 ± 112 vs. 221 ± 165 mmHg%, p = 0.03) and lower global work efficiency (GWE, 75 ± 5 vs. 82 ± 8%, p = 0.006). LV GLS ( β = −0.67, p < 0.001), ApAn+ ( β = −0.15, p = 0.04), and twist rate ( β = −0.14, p = 0.04) were independently associated with GWE. At 3.9‐year follow‐up, cardiovascular mortality (4%) and heart failure hospitalization (14%) events were similar between groups. Conclusion ApHCM patients with ApAn+ are characterized by more impaired LV mechano‐energetic coupling when compared with ApAn−. ApAn+ is independently associated with worse GWE.