Diversity of the Localization of Myocardial Hypertrophy at theApical Level in Patients with Apical Hypertrophy Evaluated byMagnetic Resonance Imaging

To evaluate the distributions of hypertrophy at the apical level in 20 patients with apical hypertrophy, end-diastolic wall thicknesses were measured on the left ventricular short axis image using magnetic resonance imaging. Distributions of hypertrophy with wall thickness equal to or more than 1.5 cm at the apical level were circumferential in 2 patients, septal-anterior-lateral in 7, septal-anterior in 2, anterior-lateral in 2, septal in 1, anterior in 3 and lateral in 3. Apical hypertrophy could not be diagnosed in 6 of 20 patients on left ventriculograms in right anterior oblique view nor on magnetic resonance long axis images corresponding to left ventriculogram, because the septal and lateral walls could not be evaluated on this view. Localized apical hypertrophy whose hypertrophied muscles are confined to the apical septum or the apical anterior wall or the apical lateral wall has been discovered. Although ‘spade like’ configuration on left ventriculography is considered as the diagnostic criterion, circumferential evaluations of the apex using short axis image are mandatory for the diagnosis.