title: The Incremental Value of Magnetic Resonance Imaging for Identification of Apical Pouch in Patients with Apical Variant of Hypertrophic Cardiomyopathy.
abstract: BACKGROUND
  The development of a left ventricular (LV) apical pouch in patients with apical hypertrophic cardiomyopathy (aHCM) has been thought to be the transition point that can become an apical aneurysm, which is linked to higher risk of adverse events. In our study, we sought to compare the ability of transthoracic echocardiography (echo) and cardiac magnetic resonance imaging (cMRI) to accurately identify the presence of an apical pouch or aneurysm in patients with aHCM.
  
  
  METHODS
  We retrospectively reviewed the charts of all consecutive patients that had features of aHCM on imaging. Data from cMRI and echo examinations were abstracted, and the ability of these diagnostic modalities to identify the presence of a LV apical pouch and aneurysm was analyzed.
  
  
  RESULTS
  Of 31 patients with aHCM, 17 (54.8%) had an apical pouch and 2 were found to have apical aneurysm (6.5%) on cMRI. Echo with and without perflutren contrast was able to accurately identify both aneurysms, but only 47.1% (8/17) of apical pouches seen by cMRI. Two patients had apical thrombus that was identified by cMRI, but not by echo.
  
  
  CONCLUSIONS
  Our findings indicate that cMRI is superior to echo in identifying apical pouches in patients with aHCM. Our results also suggest that in patients undergoing echo, the use of perflutren contrast for LV opacification increases the diagnostic yield. Further study is necessary to delineate whether earlier identification of an apical pouch will be of clinical benefit for patients with aHCM by altering clinical management and avoiding adverse cardiovascular events.
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona.
authors.forename: Darko
authors.initials: D
authors.lastname: Vucicevic
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Lester
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Appleton
authors.affiliation: Department of Radiology, Mayo Clinic, Scottsdale, Arizona.
authors.forename: Prasad M
authors.initials: PM
authors.lastname: Panse
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona.
authors.forename: John William
authors.initials: JW
authors.lastname: Schleifer
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona.
authors.forename: Susan
authors.initials: S
authors.lastname: Wilansky
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002312:Cardiomyopathy, Hypertrophic / Q000150:complications* / Q000000981:diagnostic imaging*; D004452:Echocardiography / Q000379:methods; D005260:Female; D006322:Heart Aneurysm / Q000000981:diagnostic imaging* / Q000209:etiology*; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
keywords: apical aneurysm; apical hypertrophic cardiomyopathy; apical pouch; cardiac magnetic resonance imaging; echocardiography