Apical Hypertrophic Cardiomyopathy Patients Clinical Features And Prognosis

[Background] Apical hypertrophic cardiomyopathy (AHCM) is a relatively rare type in hypertrophic cardiomyopathy (HCM). It is characterized by the giant negative T waves at ECG and a "spade-like" view of left ventricle. The hypertrophy site involves the left ventricular apex, and without obstruction of left ventricular outflow tract and pressure gradient. AHCM was described in the population with a benign prognosis.[Objective] To analyze the clinical characteristics and prognosis of Chinese patients with apical hypertrophic cardiomyopathy (AHCM)[Methods] We retrospectively reviewed283patients with AHCM evaluated by echocardiography and/or cardiac magnetic resonance (CMR) from January2005to August2012and analyzed the clinical manifestations and outcomes of them. Cox regression analysis was used to find the predictors of the cardiac events.[Result] The common presentation of283patients involved short of breath, chest pain, arrhythmias and syncope.Males predominated with a number of221(78.09%) in this cohort. Patient’s age ranged from22to85(47.15±11.04) years. The ECG was abnormal in all cases with ST-T changes. Two hundred and sixty-nine patients were followed up for (3.57±2.29) years, twenty five patients (9.3%) experienced one or more cardiovascular events. In multivariate COX analysis, Age of diagnosis (Hazard Ratio=1.055,95%CI1.016-1.095, P=0.005), LAd (Hazard Ratio=1.099,95%CI:1.032-1.170, P=0.003) and LVEF (Hazard Ratio=0.919,95%CI0.865-0.975, P=0.005) are independent prognostic factors of cardiac events.[Conclusion] The clinical presentations of AHCM varies widely, The prevalence of AHCM is high in Chinese HCM patients, and AHCM patients have a benign clinical course. A better prognosis was associated with increased LVEF, but increased Age of diagnosis and LAd were positively related to a poorer prognosis. [Background] Apical hypertrophic cardiomyopathy (AHCM) is a relatively rare type in hypertrophic cardiomyopathy (HCM). Most of these patients have ST-T changes in ECG and are easily misdiagnosed as coronary heart disease (CAD).With the rapid growth of CAG and MDCT,more and more patients of AHCM with CAD are diagnosed.But the prognosis of AHCM with CAD is still unknown.[Objective] The purpose of this study was to analyze the incidence of coronary artery disease(CAD) and the prognosis in patients with apical hypertrophic cardiomyopathy (AHCM).[Methods] We retrospectively reviewed240patients with AHCM evaluated by echocardiography and/or cardiac magnetic resonance (CMR) from January2006to August2012and underwent coronary angiography and MDCT for detecting coronary artery disease. Cox regression analysis was used to find the predictors of the cardiac events.[Result] Two hundred and forty patients were divided into normal group (143cases), myocardial bridge group(23cases) and coronary artery disease group(74cases).The CAD group was divided into three groups:single vessel coronary disease group (32cases),double vessel coronary disease group(25cases)and three vessel vessel coronary disease group(17cases). Coronary artery bypass graft and percutaneous coronary intervention(PCI) were performed in35cases. Patients with CAD had larger mean age(60.18vs55.76years, P=0.003), more hypertension(77%vs55%, P=0.002), higher level haemoglobinAic (6.21vs5.77, P=0.03). The incidence of cardiac events in CAD group was higher than normal group. LVEF (Hazard Ratio==0.826,95%CI0.746-0.915, P=0.001) and LAd (Hazard Ratio=1.423,95%CI:1.142～1.773, P=0.002) are the independent prognostic factors in AHCM with CAD.[Conclusion] Coronary artery screening is necessary in AHCM patients. CAD is a independent prognostic factor of AHCM. Increased LAd and reduced LVEF were positively related to a poorer prognosis in AHCM with CAD.