1.Diastolic dysfunction grading, echocardiographic and electrocardiogram findings in 50 patients with apical hypertrophic cardiomyopathy
Aslannif Roslan ; Suraya Hani Kamsani ; Hui Beng Koh ; Yee Sin Tey ; Kin Leong Tan ; Chan Ho Tham ; Mohd Saad Jalaluddin ; Mohamed Nazrul Mohamed Nazeeb ; Nay Thu Win ; Ahmad Tantawi Jauhari Aktifanus ; Malini Kerisnan ; Wan Nabeelah ; Muhd Najmi Hakim Abdul Rani ; Ai Ming Tan ; Amin Ariff Nuruddin
The Medical Journal of Malaysia 2019;74(6):521-526
Introduction: Apical Hypertrophic Cardiomyopathy (Apical
HCM) is an uncommon variant of hypertrophic
cardiomyopathy, but it is relatively more common in Asian
countries. This is a retrospective, non-randomised, single
centre study of patients with Apical HCM focusing on their
diastolic dysfunction grading, echocardiographic
parameters and electrocardiograms (ECG).
Methods: All Apical HCM patients coming for clinic visits at
the Institut Jantung Negara from September 2017 to
September 2018 were included. We assessed their
echocardiography images, grade their diastolic function and
reviewed their ECG on presentation.
Results: Fifty patient were included, 82% (n=41) were males
and 18% (n=9) females. The diastolic function grading of 37
(74%) patients were able to be determined using the updated
2016 American Society of Echocardiography (ASE) diastolic
guidelines. Fifty percent (n=25) had the typical ace-ofspades shape left ventricle (LV) appearance in diastole and
12% (n=6) had apical pouch. All patients had T inversion in
the anterior leads of their ECG, and only 52% (n=26) fulfilled
the ECG left ventricular hypertrophy (LVH) criteria. Majority
of our patients presented with symptoms of chest pain (52%,
n=26) and dyspnoea (42%, n=21).
Conclusion: The updated 2016 ASE guideline makes it easier
to evaluate LV diastolic function in most patients with Apical
HCM. It also helps in elucidating the aetiology of dyspnoea,
based on left atrial pressure. Clinicians should have a high
index of suspicion for Apical HCM when faced with deep T
inversion on ECG, in addition to a thick LV apex with an aceof-spades appearance during diastole.
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