title: Novel insights into the natural history of apical hypertrophic cardiomyopathy during long-term follow-up.
abstract: BACKGROUND
  Long-term follow-up in apical hypertrophic cardiomyopathy is rare.
  
  
  OBJECTIVE
  To study the natural history of the disease.
  
  
  METHODS
  We followed 11 patients, 5 women and 6 men, for 5-20 years.
  
  
  RESULTS
  At presentation all 11 patients had typical features of apical hypertrophic cardiomyopathy, with dyspnea in 3 and chest pains in 8, of whom 5 were typical of angina and 3 had myocardial infarction. R-wave voltage and T-wave negativity progressively decreased in magnitude at serial electrocardiograms in four patients. Perfusion defects were detected on thallium myocardial scintigraphy in three, increased apical uptake in two, and normal in one patient. Apical aneurysm with normal coronary arteries developed in a patient who had sustained ventricular tachycardia. All of the 10 catheterized patients had normal coronaries except for one with significant left anterior descending artery stenosis and another with a minor lesion. Symptomatic sustained ventricular tachycardia was found in two patients, one of whom required the implantation of an internal cardioverter defibrillator.
  
  
  CONCLUSIONS
  Apical hypertrophic cardiomyopathy may develop morphologic and electrocardiographic changes with life-threatening arrhythmias necessitating close follow-up and treatment.
authors.affiliation: Heart Institute, Bnai Zion Medical Center, and Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. abinader@netvision.net.il
authors.forename: Edward G
authors.initials: EG
authors.lastname: Abinader
authors.forename: Dawod
authors.initials: D
authors.lastname: Sharif
authors.forename: Arie
authors.initials: A
authors.lastname: Shefer
authors.forename: Johanan
authors.initials: J
authors.lastname: Naschitz
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization; D002312:Cardiomyopathy, Hypertrophic / Q000000981:diagnostic imaging / Q000503:physiopathology*; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging