Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
권호 표지
DOI QR코드

DOI QR Code

Impact of Coronary Artery Anatomy on Clinical Course and Prognosis in Apical Hypertrophic Cardiomyopathy: Analysis of Coronary Angiography and Computed Tomography

  • Shin, Dong Geum (Division of Cardiology, Yonsei Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Son, Jung-Woo (Division of Cardiology, Chuncheon Sacred Heart Hospital, Hallym University) ;
  • Park, Ji Young (Division of Cardiology, Department of Internal Medicine, Seoul Eulji Hospital, Eulji University School of Medicine) ;
  • Choi, Jae Woong (Division of Cardiology, Department of Internal Medicine, Seoul Eulji Hospital, Eulji University School of Medicine) ;
  • Ryu, Sung Kee (Division of Cardiology, Department of Internal Medicine, Seoul Eulji Hospital, Eulji University School of Medicine)
  • Received : 2014.06.23
  • Accepted : 2014.09.24
  • Published : 2015.01.30
⟨ Previous Next ⟩

Abstract

Background and Objectives: Apical hypertrophic cardiomyopathy (AHCM) is an uncommon variant of hypertrophic cardiomyopathy with a relatively benign course. However, the prognostic factors of AHCM-particularly those associated with coronary artery disease (CAD) and its anatomical subtypes-are not well known. Subjects and Methods: We enrolled 98 consecutive patients with AHCM who underwent coronary angiography or coronary computed tomography scanning at two general hospitals in Korea from January 2002 to March 2012. Patient charts were reviewed for information regarding cardiovascular (CV) risk factors, symptoms, and occurrence of CV events and/or mortality. We also reviewed echocardiographic data and angiography records. Results: The mean age at the time of enrollment was $61.45{\pm}9.78years$, with female patients comprising 38.6%. The proportions of mixed and pure types of AHCM were 34.4% and 65.6%, respectively. CAD was found in 31 (31.6%) patients. The mean follow-up period was $53.1{\pm}60.7months$. CV events occurred in 22.4% of patients, and the mortality rate was 5.1%. The mixed-type was more frequent in CV event group although this difference was not statistically significant (50% vs. 30%, p=0.097). The presence of CAD emerged as an independent risk factor for CV events in univariate and multivariate Cox regression analysis after adjusting for other CV risk factors. Conclusion: Coronary artery disease is an independent risk factor for CV events in AHCM patients. However, AHCM without CAD has a benign natural course, comparable with the general population.

Keywords

References

  1. Braunwald E, Lambrew CT, Rockoff SD, Ross J Jr, Morrow AG. Idiopathic hypertrophic subaortic stenosis. I. A description of the disease based upon an analysis of 64 patients. Circulation 1964;30:Suppl 4:3-119.
  2. Maron BJ, Maron MS. Hypertrophic cardiomyopathy. Lancet 2013;381:242-55. https://doi.org/10.1016/S0140-6736(12)60397-3
  3. Maron BJ, Rowin EJ, Casey SA, et al. Risk stratification and outcome of patients with hypertrophic cardiomyopathy >=60 years of age. Circulation 2013;127:585-93. https://doi.org/10.1161/CIRCULATIONAHA.112.136085
  4. Sakamoto T. Apical hypertrophic cardiomyopathy (apical hypertrophy): an overview. J Cardiol 2001;37 Suppl 1:161-78.
  5. Eriksson MJ, Sonnenberg B, Woo A, et al. Long-term outcome in patients with apical hypertrophic cardiomyopathy. J Am Coll Cardiol 2002;39:638-45. https://doi.org/10.1016/S0735-1097(01)01778-8
  6. Klues HG, Schiffers A, Maron BJ. Phenotypic spectrum and patterns of left ventricular hypertrophy in hypertrophic cardiomyopathy: morphologic observations and significance as assessed by two-dimensional echocardiography in 600 patients. J Am Coll Cardiol 1995;26:1699-708. https://doi.org/10.1016/0735-1097(95)00390-8
  7. Kitaoka H, Doi Y, Casey SA, Hitomi N, Furuno T, Maron BJ. Comparison of prevalence of apical hypertrophic cardiomyopathy in Japan and the United States. Am J Cardiol 2003;92:1183-6. https://doi.org/10.1016/j.amjcard.2003.07.027
  8. Maron MS, Finley JJ, Bos JM, et al. Prevalence, clinical significance, and natural history of left ventricular apical aneurysms in hypertrophic cardiomyopathy. Circulation 2008;118:1541-9. https://doi.org/10.1161/CIRCULATIONAHA.108.781401
  9. Yang HS, Song JK, Song JM, et al. Comparison of the clinical features of apical hypertrophic cardiomyopathy versus asymmetric septal hypertrophy in Korea. Korean J Intern Med 2005;20:111-5. https://doi.org/10.3904/kjim.2005.20.2.111
  10. Partanen J, Kupari M, Heikkila J, Keto P. Left ventricular aneurysm associated with apical hypertrophic cardiomyopathy. Clin Cardiol 1991;14:936-9. https://doi.org/10.1002/clc.4960141115
  11. Gavaliatsis IP, Kouvousis NM, Rallidis LS, et al. Recurrent atrial flutter in apical hypertrophic cardiomyopathy. Jpn Heart J 1992;33:499-504. https://doi.org/10.1536/ihj.33.499
  12. Cubukçu AA, Scott PJ, Williams GJ. Apical hypertrophic cardiomyopathy presenting as acute subendocardial myocardial infarction. Int J Cardiol 1993;38:329-32. https://doi.org/10.1016/0167-5273(93)90254-E
  13. Mitchell MA, Nath S, Thompson KA, Pagley PR, DiMarco JP. Sustained wide complex tachycardia resulting in myocardial injury in a patient with apical hypertrophic cardiomyopathy. Pacing Clin Electrophysiol 1997;20:1866-9. https://doi.org/10.1111/j.1540-8159.1997.tb03578.x
  14. Okishige K, Sasano T, Yano K, Azegami K, Suzuki K, Itoh K. Serious arrhythmias in patients with apical hypertrophic cardiomyopathy. Intern Med 2001;40:396-402. https://doi.org/10.2169/internalmedicine.40.396
  15. Sorajja P, Ommen SR, Nishimura RA, Gersh BJ, Berger PB, Tajik AJ. Adverse prognosis of patients with hypertrophic cardiomyopathy who have epicardial coronary artery disease. Circulation 2003;108:2342-8. https://doi.org/10.1161/01.CIR.0000097110.55312.BF
  16. Suganuma Y, Shinmura K, Hasegawa H, Tani M, Nakamura Y. [Clinical characteristics and cardiac events in elderly patients with apical hypertrophic cardiomyopathy]. Nihon Ronen Igakkai Zasshi 1997;34:474-81. https://doi.org/10.3143/geriatrics.34.474
  17. Elliott PM, Poloniecki J, Dickie S, et al. Sudden death in hypertrophic cardiomyopathy: identification of high risk patients. J Am Coll Cardiol 2000;36:2212-8. https://doi.org/10.1016/S0735-1097(00)01003-2
  18. Jee SH, Batty GD, Jang Y, et al. The Korean Heart Study: rationale, objectives, protocol, and preliminary results for a new prospective cohort study of 430,920 men and women. Eur J Prev Cardiol 2014;21:1484-92. https://doi.org/10.1177/2047487313497602
  19. Pasternac A, Noble J, Streulens Y, Elie R, Henschke C, Bourassa MG. Pathophysiology of chest pain in patients with cardiomyopathies and normal coronary arteries. Circulation 1982;65:778-89. https://doi.org/10.1161/01.CIR.65.4.778
  20. Sorajja P, Ommen SR, Nishimura RA, Gersh BJ, Tajik AJ, Holmes DR. Myocardial bridging in adult patients with hypertrophic cardiomyopathy. J Am Coll Cardiol 2003;42:889-94. https://doi.org/10.1016/S0735-1097(03)00854-4

Cited by

  1. Nuclear Imaging for Assessment of Myocardial Perfusion, Metabolism, and Innervation in Hypertrophic Cardiomyopathy vol.9, pp.6, 2016, https://doi.org/10.1007/s12410-016-9379-8
  2. Hypertrophic cardiomyopathy comorbid with coronary heart disease: 6-year follow-up vol.2018, pp.9, 2018, https://doi.org/10.15829/1560-4071-2018-9-48-53