Skip to main content
NCBI home page
Heart logoLink to Heart
. 2000 Jan;83(1):e1. doi: 10.1136/heart.83.1.e1

Diagnosis of apical hypertrophic cardiomyopathy using magnetic resonance imaging

T Ibrahim, M Schwaiger
PMCID: PMC1729253  PMID: 10618355

Abstract

Apical hypertrophic cardiomyopathy is an uncommon variant of non-obstructive hypertrophic cardiomyopathy with low prevalence outside East Asia. A case is reported of a non-Asian (European) 51 year old man with characteristic ECG and morphological changes of apical hypertrophic cardiomyopathy. Although the patient underwent catheterisation three years previously because of suggested coronary ischaemic heart disease, apical hypertrophic cardiomyopathy was not diagnosed. More recently, a regional wall motion abnormality was noticed at the apex on echocardiography. To rule out an ischaemic injury a stress perfusion scintigraphy was performed; no perfusion defect was present but an apical tracer enhancement was noted. Further evaluation by magnetic resonance imaging revealed the pathognomonic "ace of spades" configuration of the left ventricle with systolic obliteration of the apical region, which led to the diagnosis of apical hypertrophic cardiomyopathy.


Keywords: apical hypertrophic cardiomyopathy; magnetic resonance imaging

Full Text

The Full Text of this article is available as a PDF (142.9 KB).

Figure 1  .

Figure 1  

Open in a new tab

ECG at rest with negative T waves in the precordial leads and a positive Sokolow-Lyon index (4.1 mV) as signs of left ventricular hypertrophy.

Figure 2  .

Figure 2  

Open in a new tab

Gated SPECT images showing a rich perfusion pattern in the apical region at rest (top) and under stress (bottom).    

Figure 3  .

Figure 3  

Open in a new tab

Spade-like configuration of the left ventricle at end diastole (top) in two chamber magnetic resonance images with obliteration of the distal cavity at end systole (bottom) (fast gradient echo technique).

Figure 4  .

Figure 4  

Open in a new tab

Basal short axis magnetic resonance images (left) show normal diastolic wall thickness at end diastole (above) and end systole (below). Distal short axis slices (right) reveal the apical hypertrophy at end diastole (above) with obstruction of the cavity at end systole (below) (fast gradient echo technique).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Keren G., Belhassen B., Sherez J., Miller H. I., Megidish R., Berenfeld D., Laniado S. Apical hypertrophic cardiomyopathy: evaluation by noninvasive and invasive techniques in 23 patients. Circulation. 1985 Jan;71(1):45–56. doi: 10.1161/01.cir.71.1.45. [DOI] [PubMed] [Google Scholar]
  2. Kishimoto C., Takada H., Hiraoka Y., Suzaki M., Maruya E., Tomioka N. HLA-DR2 antigen linkage in patients with apical hypertrophic cardiomyopathy in Japan. Cardiology. 1996 Nov-Dec;87(6):488–491. doi: 10.1159/000177143. [DOI] [PubMed] [Google Scholar]
  3. Maron B. J., Bonow R. O., Seshagiri T. N., Roberts W. C., Epstein S. E. Hypertrophic cardiomyopathy with ventricular septal hypertrophy localized to the apical region of the left ventricle (apical hypertrophic cardiomyopathy). Am J Cardiol. 1982 Jun;49(8):1838–1848. doi: 10.1016/0002-9149(82)90200-4. [DOI] [PubMed] [Google Scholar]
  4. Sakamoto T., Tei C., Murayama M., Ichiyasu H., Hada Y. Giant T wave inversion as a manifestation of asymmetrical apical hypertrophy (AAH) of the left ventricle. Echocardiographic and ultrasono-cardiotomographic study. Jpn Heart J. 1976 Sep;17(5):611–629. doi: 10.1536/ihj.17.611. [DOI] [PubMed] [Google Scholar]
  5. Slama M. A., Tribouilloy C., Bickert P., Caze F., Jobic Y., Darras B., Lesbre J. P. Myocardiopathie hypertrophique apicale avec obstruction médio-ventriculaire et nécrose apicale. Arch Mal Coeur Vaiss. 1989 Sep;82(9):1623–1627. [PubMed] [Google Scholar]
  6. Soler R., Rodríguez E., Rodríguez J. A., Pérez M. L., Penas M. Magnetic resonance imaging of apical hypertrophic cardiomyopathy. J Thorac Imaging. 1997 Jul;12(3):221–225. doi: 10.1097/00005382-199707000-00010. [DOI] [PubMed] [Google Scholar]
  7. Suzuki J., Shimamoto R., Nishikawa J., Yamazaki T., Tsuji T., Nakamura F., Shin W. S., Nakajima T., Toyo-Oka T., Ohotomo K. Morphological onset and early diagnosis in apical hypertrophic cardiomyopathy: a long term analysis with nuclear magnetic resonance imaging. J Am Coll Cardiol. 1999 Jan;33(1):146–151. doi: 10.1016/s0735-1097(98)00527-0. [DOI] [PubMed] [Google Scholar]
  8. Suzuki J., Watanabe F., Takenaka K., Amano K., Amano W., Igarashi T., Aoki T., Serizawa T., Sakamoto T., Sugimoto T. New subtype of apical hypertrophic cardiomyopathy identified with nuclear magnetic resonance imaging as an underlying cause of markedly inverted T waves. J Am Coll Cardiol. 1993 Oct;22(4):1175–1181. doi: 10.1016/0735-1097(93)90434-3. [DOI] [PubMed] [Google Scholar]
  9. Webb J. G., Sasson Z., Rakowski H., Liu P., Wigle E. D. Apical hypertrophic cardiomyopathy: clinical follow-up and diagnostic correlates. J Am Coll Cardiol. 1990 Jan;15(1):83–90. doi: 10.1016/0735-1097(90)90180-w. [DOI] [PubMed] [Google Scholar]
  10. Yamaguchi H., Ishimura T., Nishiyama S., Nagasaki F., Nakanishi S., Takatsu F., Nishijo T., Umeda T., Machii K. Hypertrophic nonobstructive cardiomyopathy with giant negative T waves (apical hypertrophy): ventriculographic and echocardiographic features in 30 patients. Am J Cardiol. 1979 Sep;44(3):401–412. doi: 10.1016/0002-9149(79)90388-6. [DOI] [PubMed] [Google Scholar]

Articles from Heart are provided here courtesy of BMJ Publishing Group

RESOURCES