title: Functional, morphological and electrocardiographical abnormalities in patients with apical hypertrophic cardiomyopathy and apical aneurysm: correlation with cardiac MR.
abstract: The prognosis of apical hypertrophic cardiomyopathy (APH) has been benign, but apical myocardial injury has prognostic importance. We studied functional, morphological and electrocardiographical abnormalities in patients with APH and with apical aneurysm and sought to find parameters that relate to apical myocardial injury.
  
  
  
  
  
  
  
  a multicentre trans-sectional study.
  
  
  
  45 patients with APH and 5 with apical aneurysm diagnosed with transthoracic echocardiography (TTE) in the database of Hamamatsu Circulation Forum.
  
  
  
  the apical contraction with cine-cardiac MR (CMR), the myocardial fibrotic scar with late gadolinium enhancement (LGE)-CMR, and QRS fragmentation (fQRS) defined when two ECG-leads exhibited RSR's patterns.
  
  
  
  Cine-CMR revealed 27 patients with normal, 12 with hypokinetic and 11 with dyskinetic apical contraction. TTE misdiagnosed 11 (48%) patients with hypokinetic and dyskinetic contraction as those with normal contraction. Apical LGE was apparent in 10 (83%) and 11 (100%) patients with hypokinetic and dyskinetic contraction, whereas only in 11 patients (41%) with normal contraction (p<0.01). Patients with dyskinetic apical contraction had the lowest left ventricular ejection fraction, the highest prevalence of ventricular tachycardia, and the smallest ST depression and depth of negative T waves. The presence of fQRS was associated with impaired apical contraction and apical LGE (OR=8.32 and 8.61, p<0.05).
  
  
  
  CMR is superior to TTE for analysing abnormalities of the apex in patients with APH and with apical aneurysm. The presence of fQRS can be a promising parameter for the early detection of apical myocardial injury.
authors.affiliation: The Investigator Group , Hamamatsu Circulation Forum ; (Hamamatsu Circulation Forum consists of Enshu Hospital, Hamamatsu University Hospital, Hamamatsu Red Cross Hospital, Kosai General Hospital and Seirei Mikatahara Hospital.).
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Suwa
authors.affiliation: The Investigator Group , Hamamatsu Circulation Forum ; (Hamamatsu Circulation Forum consists of Enshu Hospital, Hamamatsu University Hospital, Hamamatsu Red Cross Hospital, Kosai General Hospital and Seirei Mikatahara Hospital.) ; Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Satoh
authors.affiliation: The Investigator Group , Hamamatsu Circulation Forum ; (Hamamatsu Circulation Forum consists of Enshu Hospital, Hamamatsu University Hospital, Hamamatsu Red Cross Hospital, Kosai General Hospital and Seirei Mikatahara Hospital.).
authors.forename: Makoto
authors.initials: M
authors.lastname: Sano
authors.affiliation: The Investigator Group , Hamamatsu Circulation Forum ; (Hamamatsu Circulation Forum consists of Enshu Hospital, Hamamatsu University Hospital, Hamamatsu Red Cross Hospital, Kosai General Hospital and Seirei Mikatahara Hospital.).
authors.forename: Mamoru
authors.initials: M
authors.lastname: Nobuhara
authors.affiliation: The Investigator Group , Hamamatsu Circulation Forum ; (Hamamatsu Circulation Forum consists of Enshu Hospital, Hamamatsu University Hospital, Hamamatsu Red Cross Hospital, Kosai General Hospital and Seirei Mikatahara Hospital.).
authors.forename: Takeji
authors.initials: T
authors.lastname: Saitoh
authors.affiliation: The Investigator Group , Hamamatsu Circulation Forum ; (Hamamatsu Circulation Forum consists of Enshu Hospital, Hamamatsu University Hospital, Hamamatsu Red Cross Hospital, Kosai General Hospital and Seirei Mikatahara Hospital.).
authors.forename: Masao
authors.initials: M
authors.lastname: Saotome
authors.affiliation: The Investigator Group , Hamamatsu Circulation Forum ; (Hamamatsu Circulation Forum consists of Enshu Hospital, Hamamatsu University Hospital, Hamamatsu Red Cross Hospital, Kosai General Hospital and Seirei Mikatahara Hospital.).
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Urushida
authors.affiliation: The Investigator Group , Hamamatsu Circulation Forum ; (Hamamatsu Circulation Forum consists of Enshu Hospital, Hamamatsu University Hospital, Hamamatsu Red Cross Hospital, Kosai General Hospital and Seirei Mikatahara Hospital.).
authors.forename: Hideki
authors.initials: H
authors.lastname: Katoh
authors.affiliation: The Investigator Group , Hamamatsu Circulation Forum ; (Hamamatsu Circulation Forum consists of Enshu Hospital, Hamamatsu University Hospital, Hamamatsu Red Cross Hospital, Kosai General Hospital and Seirei Mikatahara Hospital.).
authors.forename: Kei
authors.initials: K
authors.lastname: Tawarahara
authors.affiliation: The Investigator Group , Hamamatsu Circulation Forum ; (Hamamatsu Circulation Forum consists of Enshu Hospital, Hamamatsu University Hospital, Hamamatsu Red Cross Hospital, Kosai General Hospital and Seirei Mikatahara Hospital.).
authors.forename: Hayato
authors.initials: H
authors.lastname: Ohtani
authors.affiliation: The Investigator Group , Hamamatsu Circulation Forum ; (Hamamatsu Circulation Forum consists of Enshu Hospital, Hamamatsu University Hospital, Hamamatsu Red Cross Hospital, Kosai General Hospital and Seirei Mikatahara Hospital.).
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Wakabayashi
authors.affiliation: The Investigator Group , Hamamatsu Circulation Forum ; (Hamamatsu Circulation Forum consists of Enshu Hospital, Hamamatsu University Hospital, Hamamatsu Red Cross Hospital, Kosai General Hospital and Seirei Mikatahara Hospital.).
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Takase
authors.affiliation: The Investigator Group , Hamamatsu Circulation Forum ; (Hamamatsu Circulation Forum consists of Enshu Hospital, Hamamatsu University Hospital, Hamamatsu Red Cross Hospital, Kosai General Hospital and Seirei Mikatahara Hospital.).
authors.forename: Hajime
authors.initials: H
authors.lastname: Terada
authors.affiliation: Department of Radiology , Hamamatsu University School of Medicine , Hamamatsu , Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Takehara
authors.affiliation: Department of Radiology , Hamamatsu University School of Medicine , Hamamatsu , Japan.
authors.forename: Harumi
authors.initials: H
authors.lastname: Sakahara
authors.affiliation: The Investigator Group , Hamamatsu Circulation Forum ; (Hamamatsu Circulation Forum consists of Enshu Hospital, Hamamatsu University Hospital, Hamamatsu Red Cross Hospital, Kosai General Hospital and Seirei Mikatahara Hospital.).
authors.forename: Hideharu
authors.initials: H
authors.lastname: Hayashi