Cardiac magnetic resonance as a risk re-stratification tool in apical hypertrophic cardiomyopathy

Ana María Larriva; Sandra Rosales Uvera; Zuilma Vásquez; Beatriz Fernández; Diego Xavier Chango Azanza

doi:10.47487/apcyccv.v4i2.289

Autores/as

Ana María Larriva Servicio de Cardiología, Clínica Santa Ana, Cuenca, Ecuador. https://orcid.org/0000-0003-2956-6318
Sandra Rosales Uvera Servicio de Imagen Cardiovascular, Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán», Cuidad de México, Mexico.
Zuilma Vásquez Servicio de Imagen Cardiovascular, Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán», Cuidad de México, Mexico. https://orcid.org/0000-0001-5956-7333
Beatriz Fernández Servicio de Imagen Cardiovascular, Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán», Cuidad de México, Mexico.
Diego Xavier Chango Azanza Servicio de Cardiología, Clínica Santa Ana, Cuenca, Ecuador. https://orcid.org/0000-0002-6376-3051

DOI:

https://doi.org/10.47487/apcyccv.v4i2.289

Palabras clave:

Apical Hypertrophic Cardiomyopathy, Cardiac Aneurysm, Echocardiography, Cardiac Magnetic Resonance

Resumen

Apical hypertrophic cardiomyopathy (ApHCM) can result in the formation of a left ventricular apical aneurysm and progressive myocardial fibrosis, which is associated with a worse prognosis. We present the case of a 76-year-old man previously diagnosed with ApHCM seven years ago, who has been under clinical follow-up. Serial cardiac magnetic resonance (CMR) imaging was performed in 2013 and 2020 due to suspected apical aneurysm formation based on echocardiographic evaluation. The 2020 CMR imaging revealed an increase in myocardial fibrosis observed through late-gadolinium enhancement images and, for the first time, a small apical aneurysm that was not clearly visualized on two-dimensional echocardiography. The time course leading to the development of an ApHCM aneurysm is not well-defined and may impact the clinical course.

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Referencias

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patients with ApHCM, aneurysm formation was related to four stages for its development, starting with systolic apical cavity obliteration, then broadening of the apical slit in systole, further developing into an apical outpouching, and finally forming an apical aneurysm. Nevertheless, further investigations are required to clarify time progression and established specific CMR follow- up recommendations.

In conclusion, apical aneurysm detection in ApHCM is a valuable strategy for identifying patients at higher risk of cardiovascular events. Echocardiography is the primary modality for assessment and monitoring, while CMR imaging plays a confirmatory role in inconclusive cases. Regular imaging follow- up is recommended to detect aneurysm formation and assess the progression of myocardial fibrosis, enabling re-evaluation of the risk of SCD. In this case, CMR imaging played a crucial role in re- stratification.

Author ́s contributions: AML and DC: Data curation, investigation, writing, review and editing. SRU, ZV and BF: Writing, review and editing.

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