Left Ventricular Apex Involvement in Hypertrophic Cardiomyopathy

Hypertrophic Cardiomyopathy (HCM) is the most frequent inherited heart muscle disease, characterized by extreme clinical and morphological heterogeneity. All segments of the left ventricular (LV) wall may be hypertrophied in HCM, although a basal anteroseptal localization of hypertrophy is by far the most common pattern. Apical left ventricular (LV) hypertrophy is present in a minority of consecutive HCM patients, and often underestimated by transthoracic echocardiography. Furthermore, the apex may be involved in the HCM disease process by aneurysm formation, often associated with mid-ventricular obstruction. We here present a series of three HCM patients reflecting the spectrum of LV apex involvement and discuss the implications of these uncommon clinical variants.