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Morphological onset and early diagnosis in apical hypertrophic cardiomyopathy: a long term analysis with nuclear magnetic resonance imaging

^a Second Department of Internal Medicine, Faculty of Medicine, University of Tokyo, Tokyo, Japan
^* Department of Radiology, Faculty of Medicine, University of Tokyo, Tokyo, Japan

View larger version (40K): [in a new window]   Figure 1 Electrocardiogram obtained at first NMR examination from patient 5 in group 1 shows inverted T waves (negativity: 14 mm = 1.4 mV) with high peaked R waves.

View larger version (27K): [in a new window]   Figure 2 Schematic representation of morphological features of classical apical HCM with spadelike configuration (left) and apically predominant HCM with nonspade configuration (right). Top shows long-axis images corresponding to LVG in right anterior oblique projection. Bottom shows short-axis images obtained at basal level and at apical level. Dotted lines on long-axis images represent levels for setting basal and apical imaging planes for short-axis images. Dotted line on each short-axis image indicates imaging plane for long-axis image which corresponds to LVG in right anterior oblique projection. Localization of hypertrophied myocardium at apical level is circumferential in spadelike configuration and it is confined to a small region, for example, to the lateral wall at apical level in nonspade configuration. Note that hypertrophied myocardium confined to lateral wall is not delineated on long-axis image. T(A,a) = anterior wall thickness at apical level; T(A,m) = maximal wall thickness at apical level; T(A,p) = posterior wall thickness at apical level; T(B,a) = anterior wall thickness at basal level; T(B,m) = maximal wall thickness at basal level; T(B,p) = posterior wall thickness at basal level.

View larger version (94K): [in a new window]   Figure 3 End-diastolic left ventricular short-axis NMR images at apical level obtained at first (top) and second (bottom) examination from patients 1 with follow-up period of 60 months. Site of apical hypertrophy that was confined to lateral wall at first examination involved anterior wall and posterior wall after follow-up period. a = anterior wall at apical level; l = lateral wall at apical level; p = posterior wall at apical level; s = interventricular septum at apical level.

View larger version (88K): [in a new window]   Figure 4 End-diastolic short-axis NMR images of left ventricular apex obtained at first (top, by spin-echo) and second (bottom, by turboFLASH) studies from patient-5. Anterior-lateral hypertrophy developed to become circumferential after follow-up period of 72 months. Abbreviations as in Figure 3.