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Contrast Echocardiography in Apical Hypertrophic Cardiomyopathy

2006; Lippincott Williams & Wilkins; Volume: 114; Issue: 2 Linguagem: Inglês

10.1161/circulationaha.105.600858

1524-4539

Harun Otieno, Yoel Vivas, Darren Traub, Asha Raman, Chandra Polam,

Cardiovascular Function and Risk Factors

HomeCirculationVol. 114, No. 2Contrast Echocardiography in Apical Hypertrophic Cardiomyopathy Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialFree AccessReview ArticlePDF/EPUBContrast Echocardiography in Apical Hypertrophic Cardiomyopathy Harun Otieno, Yoel Vivas, Darren Traub, Asha Raman and Chandra Polam Harun OtienoHarun Otieno From The Western Pennsylvania Hospital, Department of Echocardiography, Division of Cardiology, Pittsburgh, Pa. , Yoel VivasYoel Vivas From The Western Pennsylvania Hospital, Department of Echocardiography, Division of Cardiology, Pittsburgh, Pa. , Darren TraubDarren Traub From The Western Pennsylvania Hospital, Department of Echocardiography, Division of Cardiology, Pittsburgh, Pa. , Asha RamanAsha Raman From The Western Pennsylvania Hospital, Department of Echocardiography, Division of Cardiology, Pittsburgh, Pa. and Chandra PolamChandra Polam From The Western Pennsylvania Hospital, Department of Echocardiography, Division of Cardiology, Pittsburgh, Pa. Originally published11 Jul 2006https://doi.org/10.1161/CIRCULATIONAHA.105.600858Circulation. 2006;114:e33–e34The patient was a 43-year-old asymptomatic Indian male referred for evaluation of an abnormal ECG obtained at a routine check-up. His cardiovascular risk factors included hyperlipidemia and a family history of premature coronary artery disease. His physical examination was unremarkable. The ECG (Figure 1) showed sinus rhythm with evidence of left ventricular hypertrophy, ST-segment elevation in the inferior leads III and aVF, and giant negative T waves in the precordial leads. Two-dimensional (Movie I) and contrast echocardiography (Movie II) with DEFINITY (Perflutren lipid microspheres, Bristol-Myers Squibb Medical Imaging, Inc, N. Billerica, Mass) were performed, revealing severe apical hypertrophy with the absence of a dynamic left ventricular outflow tract gradient. Radiocontrast left ventriculography (Figure 2) demonstrated the characteristic "ace-of-spades" left ventricular cavity, confirming the diagnosis of apical hypertrophic cardiomyopathy. The coronary arteries were free of obstructive disease. Download figureDownload PowerPointFigure 1. ECG showing inferior ST-segment elevation and precordial giant negative T waves.Download figureDownload PowerPointFigure 2. Characteristic "ace-of-spades" left ventriculogram demonstrating marked apical hypertrophy.This case demonstrates the classical electrocardiographic, echocardiographic, and ventriculographic features of apical hypertrophic cardiomyopathy (frequently referred to as "Yamagushi Syndrome"). This unusual form of hypertrophic cardiomyopathy localized to the left ventricular apex was first described in Japan1 in 1976 and is particularly uncommon in the United States. The concave upward ST-segment elevation is likely secondary to repolarization changes caused by extensive myocardial hypertrophy. The patient was reassured and discharged on lipid-lowering therapy with instructions to keep a copy of his "signature" ECG in his wallet. He denied experiencing any palpitations or syncope and his family history was negative for premature sudden death. His family members were advised to seek medical attention for screening purposes.The online-only Data Supplement, which contains 2 movies, can be found at http://circ.ahajournals.org/cgi/content/full/114/2/e33/DC1.DisclosuresNone.FootnotesCorrespondence to Dr Harun Otieno, MD, Suite 3411 North, 4800 Friendship Ave, Pittsburgh, PA 15224. E-mail [email protected]Reference1 Yamagushi H, Nakanishi S, Nishijo T, Nagasaki F, Matsumoto S, Ishimura T. Hypertrophic cardiomyopathy with giant negative T waves. Jpn Circ J. 1976; 40 (suppl): 110.Google Scholar eLetters(0)eLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. Comments are not peer-reviewed. Acceptable comments are posted to the journal website only. Comments are not published in an issue and are not indexed in PubMed. Comments should be no longer than 500 words and will only be posted online. References are limited to 10. Authors of the article cited in the comment will be invited to reply, as appropriate.Comments and feedback on AHA/ASA Scientific Statements and Guidelines should be directed to the AHA/ASA Manuscript Oversight Committee via its Correspondence page.Sign In to Submit a Response to This Article Previous Back to top Next FiguresReferencesRelatedDetailsCited By Moccetti F and Lindner J (2019) Utilizing Contrast Echocardiography in Practice Essential Echocardiography, 10.1016/B978-0-323-39226-6.00012-6, (130-139.e3), . Garg T and Luijkx T (2015) Ace-of-spades sign (heart) Radiopaedia.org, 10.53347/rID-34368 Ibrahim E (2011) Myocardial tagging by Cardiovascular Magnetic Resonance: evolution of techniques–pulse sequences, analysis algorithms, and applications, Journal of Cardiovascular Magnetic Resonance, 10.1186/1532-429X-13-36, 13:1, Online publication date: 1-Dec-2011. Schuster A and Nagel E (2011) Toward Full Quantification of Wall Motion with MRI, Current Cardiovascular Imaging Reports, 10.1007/s12410-011-9072-x, 4:2, (85-86), Online publication date: 1-Apr-2011. Lawton J, Cupps B, Knutsen A, Ma N, Brady B, Reynolds L and Pasque M (2011) Magnetic resonance imaging detects significant sex differences in human myocardial strain, BioMedical Engineering OnLine, 10.1186/1475-925X-10-76, 10:1, (76), . Yıldırım M, Selçoki Y and Eryonucu B Apical Hypertrophic Cardiomyopathy, Electronic Journal of General Medicine, 10.29333/ejgm/82853, 7:2, (206-209) Carlsson M, Osman N, Ursell P, Martin A and Saeed M (2008) Quantitative MR measurements of regional and global left ventricular function and strain after intramyocardial transfer of VM202 into infarcted swine myocardium, American Journal of Physiology-Heart and Circulatory Physiology, 10.1152/ajpheart.00280.2008, 295:2, (H522-H532), Online publication date: 1-Aug-2008. July 11, 2006Vol 114, Issue 2 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.105.600858PMID: 16831990 Originally publishedJuly 11, 2006 PDF download Advertisement SubjectsEchocardiographyHypertrophy