title: Diagnosis of apical hypertrophic cardiomyopathy: T-wave inversion and relative but not absolute apical left ventricular hypertrophy.
abstract: BACKGROUND
  Diagnosis of apical HCM utilizes conventional wall thickness criteria. The normal left ventricular wall thins towards the apex such that normal values are lower in the apical versus the basal segments. The impact of this on the diagnosis of apical hypertrophic cardiomyopathy has not been evaluated.
  
  
  METHODS
  We performed a retrospective review of 2662 consecutive CMR referrals, of which 75 patients were identified in whom there was abnormal T-wave inversion on ECG and a clinical suspicion of hypertrophic cardiomyopathy. These were retrospectively analyzed for imaging features consistent with cardiomyopathy, specifically: relative apical hypertrophy, left atrial dilatation, scar, apical cavity obliteration or apical aneurysm. For comparison, the same evaluation was performed in 60 healthy volunteers and 50 hypertensive patients.
  
  
  RESULTS
  Of the 75 patients, 48 met conventional HCM diagnostic criteria and went on to act as another comparator group. Twenty-seven did not meet criteria for HCM and of these 5 had no relative apical hypertrophy and were not analyzed further. The remaining 22 patients had relative apical thickening with an apical:basal wall thickness ratio >1 and a higher prevalence of features consistent with a cardiomyopathy than in the control groups with 54% having 2 or more of the 4 features. No individual in the healthy volunteer group had more than one feature and no hypertension patient had more than 2.
  
  
  CONCLUSIONS
  A cohort of individuals exist with T wave inversion, relative apical hypertrophy and additional imaging features of HCM suggesting an apical HCM phenotype not captured by existing diagnostic criteria.
authors: Department of Cardiology, University Hospital Southampton, Tremona Road, Southampton SO166YD, United Kingdom.
authors: Andrew S
authors: AS
authors: Flett
authors: The Heart Hospital, part of University College London Hospitals NHS Trust, 16-18 Westmoreland Street, London W1G 8P, United Kingdom.
authors: Viviana
authors: V
authors: Maestrini
authors: The Heart Hospital, part of University College London Hospitals NHS Trust, 16-18 Westmoreland Street, London W1G 8P, United Kingdom.
authors: Don
authors: D
authors: Milliken
authors: The Heart Hospital, part of University College London Hospitals NHS Trust, 16-18 Westmoreland Street, London W1G 8P, United Kingdom.
authors: Mariana
authors: M
authors: Fontana
authors: The Heart Hospital, part of University College London Hospitals NHS Trust, 16-18 Westmoreland Street, London W1G 8P, United Kingdom.
authors: Thomas A
authors: TA
authors: Treibel
authors: The Heart Hospital, part of University College London Hospitals NHS Trust, 16-18 Westmoreland Street, London W1G 8P, United Kingdom.
authors: Rami
authors: R
authors: Harb
authors: The Heart Hospital, part of University College London Hospitals NHS Trust, 16-18 Westmoreland Street, London W1G 8P, United Kingdom; Institute of Cardiovascular Science, University College London, United Kingdom.
authors: Daniel M
authors: DM
authors: Sado
authors: Department of Cardiology, S Andrea Hospital, Universtiy Sapienza Rome, Italy; Cardiovascular Department, AO Papa Giovanni XXIII, Bergamo, Italy.
authors: Giovanni
authors: G
authors: Quarta
authors: The Heart Hospital, part of University College London Hospitals NHS Trust, 16-18 Westmoreland Street, London W1G 8P, United Kingdom.
authors: Anna
authors: A
authors: Herrey
authors: East Surrey Hospital, Canada Avenue, Redhill RH1 5RH, United Kingdom.
authors: James
authors: J
authors: Sneddon
authors: The Heart Hospital, part of University College London Hospitals NHS Trust, 16-18 Westmoreland Street, London W1G 8P, United Kingdom; Institute of Cardiovascular Science, University College London, United Kingdom.
authors: Perry
authors: P
authors: Elliott
authors: The Heart Hospital, part of University College London Hospitals NHS Trust, 16-18 Westmoreland Street, London W1G 8P, United Kingdom; Institute of Cardiovascular Science, University College London, United Kingdom.
authors: William
authors: W
authors: McKenna
authors: The Heart Hospital, part of University College London Hospitals NHS Trust, 16-18 Westmoreland Street, London W1G 8P, United Kingdom; Institute of Cardiovascular Science, University College London, United Kingdom. Electronic address: James.moon@uclh.nhs.uk.
authors: James C
authors: JC
authors: Moon
mesh_terms: D000368:Aged; D002312:Cardiomyopathy, Hypertrophic / Q000175:diagnosis*; D017023:Coronary Angiography / Q000379:methods / Q000706:statistics & numerical data; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis*; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
keywords: Cardiovascular magnetic resonance; Hypertrophic cardiomyopathy