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Morphological onset and early diagnosis in apical hypertrophic cardiomyopathy : a long term analysis with nuclear magnetic resonance imaging . OBJECTIVES A long-term follow-up study with nuclear magnetic resonance ( NMR ) imaging was undertaken to detect the morphological onset and to establish the early diagnosis in apical hypertrophic cardiomyopathy ( HCM ) . BACKGROUND A spadelike configuration on left ventriculogram ( LVG ) is regarded as a diagnostic criterion for the classical apical HCM . There also exists a segmented hypertrophy at the apical level without indicating the spadelike features ( a nonspade configuration ) . To detect the hypertrophied myocardium of the nonspade configuration , circumferential scrutiny of the apex is required . Although both configurations can be underlying causes of giant negative T waves , etiological relationship between the two is not clarified . METHODS The criteria for the spadelike configuration defined on left ventricular short-axis NMR images were as follows : ( apical maximal thickness > or = 15 mm ) , ( apical anterior thickness over basal anterior thickness > or = 1.3 ) and ( apical posterior thickness over basal posterior thickness > or =1.3 ) . Thirteen patients who had predominant hypertrophy ( > or = 15 mm ) at the apical level without the spadelike configuration underwent NMR imaging twice before and after 54+/-10 months ' follow-up . RESULTS Apical hypertrophy that had been confined to the lateral wall in four , the anterior-lateral wall in two , and the septal-anterior wall in one developed to become circumferential hypertrophy that fulfilled the criteria for the spadelike configuration after the follow-up period . CONCLUSIONS The spadelike configuration can begin with the nonspade configuration and therefore , both can constitute a single disease entity of apical HCM . The early diagnosis of apical HCM can be achieved by identifying the hypertrophy frequently confined to the lateral wall at the apical level .
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Intervention_Other
nuclear magnetic resonance imaging
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Intervention_Other
nuclear magnetic resonance ( NMR ) imaging
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Intervention_Physical
NMR images
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Intervention_Other
NMR imaging twice before and after 54+/-10 months
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Outcome_Physical
left ventriculogram ( LVG )
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Outcome_Other
segmented hypertrophy at the apical level
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Outcome_Physical
Apical hypertrophy
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Outcome_Physical
circumferential hypertrophy
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Outcome_Other
apical HCM
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Outcome_Other
hypertrophy
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Participant_Condition
apical hypertrophic cardiomyopathy :
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Participant_Condition
Thirteen patients who had predominant hypertrophy ( > or = 15 mm ) at the apical level without the spadelike configuration underwent NMR imaging twice before and after 54+/-10 months ' follow-up .