Abstract
To clarify apical hypertrophy (APH), I compared family history, the participation of hypertension, ECG findings, clinical course, prognosis, left ventriculogram, and endomyocardial biopsy (EMB) findings in a total of 87 patients with APH and various types of hypertrophic cardiomyopathies.
The subjects consisted of 28 patients with APH only, 24 with asymmetrical septal hypertrophy (ASH only), 13 with combined APH and ASH (APH+ASH), 12 with diffuse left ventricular hypertrophy (diffuse type) and 10 with hypertrophic obstructive cardiomyopathy (HOCM). Histological findings of EMB specimens were classified as O, 1+, 2+, for myocyte hypertrophy and disarray. LV wall thickness measured on end-diastolic frames of RAO-LV gram was compared with the maximal depth of negative T waves on ECG.
Results were as follows :
(1) Significant abnormality on EMB was found in 46% of patients with pure APH, and in 54, 54, 58, and 60% of those with APH+ASH, pure ASH, diffuse type, and HOCM, respectively. (2) EMB sampling from the left ventricle showed a higher incidence of abnormality than that from the right ventricle. (3) Participation of hypertension was relatively low at the 20% level in every group except in the APH+ASH Group, which was at 46%. (4) Although the number of patients with APH only was limited to 18 in this series, no cardiac deaths were observed and cardiac complications were noted in only two patients. (5) Maximal negative T depth/QRS voltage correlated positively to the ratio of mid ventricular thickness/apical thickness.
Conclusion : (1) Certain APH patients could be categolized as a subtype of HCM, in whom hypertrophy and disarray were limited to the apical portion. (2) It is more useful to obtain EMB from left ventricle than from the right ventricle for diagnosis of HCM. (3) Regarding complications, the prognosis of APH remains unclear. Further study of the longterm prognosis is important because cardiac complications cannot be ignored. (4) The depth of negative T waves in APH patients seemed to be related to the disparity in the distribution of thickness from the middle to apical segments of the left ventricle.
