Is Apical variant of Hypertrophic Cardiomyopathy benign ?

4 June 2006

Dear Sir,

In their excellent review of management of Hypertrophic Cardiomyopathy, Spirito & Autore [1] have not discussed Apical form of hypertrophic cardiomyopathy. Approximately 25% of cases of hypertrophic cardiomyopathy may belong to apical variant in Japan[2]. It is quite frequently seen in other tropical countries like India. We in Indian Armed Forces see it quite frequently as routine ECG is part of annual medical examination. A ‘horrible’ looking ECG with giant T-wave inversions (defined as more than 10 mm in depth) is the usual cause of referral to physician and confirmation of diagnosis by echocardiography. Apical hypertrophic cardiomyopathy is rare in Western Countries. Strangely mild T -wave inversions have been reported from West as compared to giant T-wave inversions in the East [3].

Does the management of Apical hypertrophic cardiomyopathy differ from other cases of hypertrophic cardiomyopathy? Sudden death has been reported to occur in Apical hypertrophic cardiomyopathy patients and in their first degree relatives in west [3]. Japanese workers have described this subgroup of hypertrophic cardiomyopathy to be relatively benign[4]. However, their long term prognosis and risk of sudden cardiac death has not been clearly defined. Perhaps the management strategies in these cases will be dictated by patient’s symptoms. Majority of these patients do not need infective endocarditis prophylaxis as they usually have no features of obstruction. Should their first degree relatives need to be aggressively screened specially in countries with scarce health resources is not very clear.

References :

1. Spirito P & Autore C. Management of Hypertrophic Cardiomyopathy. BMJ 2006; 332 : 1251-1255.

2. Wynne J & Braunwald E. The Cardiomyopathies. In Zipes DP, Libby P, Bonow RO& Braunwald E (Eds) Braunwald’s Heart Disease, 7th ed, Elsevier Saunders 2005: p1659-1696.

3. Maron BJ, Bonow RO, Seshagiri TNR, Roberts WC & Epstein SE. Hypertrophic Cardiomyopathy With Ventricular Septal Hypertrophy Localized to the Apical Region of the Left Ventricle (Apical Hypertrophic Cardiomyopathy).

Am J Cardiol 1982; 49: 1838-1848.

4. Maron BJ. Hypertrophic Cardiomyopathy in Fuster V, Alexander RW , O’Rourke RA et al (Eds) Hurst’s The Heart, 10th ed Mcgraw-Hill 2001 : p1967-1987.

Competing interests: None declared

Competing interests: None declared

Kuldip P Anand, Head Dept of Medicine

Ajit S Kashyap, Surekha Kashyap

Command Hospital Kolkata 70027, India

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