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Archives of cardiovascular diseases
Volume 103, n° 4
pages 273-274 (avril 2010)
Doi : 10.1016/j.acvd.2009.09.014
Received : 5 September 2009 ;  accepted : 14 September 2009
Apical hypertrophic cardiomyopathy or left ventricular non-compaction?
Cardiomyopathie hypertrophique apicale ou ventricule gauche non compacté ?

Óscar Prada, Alberto Bouzas-Mosquera , Nemesio Álvarez-García
Department of Cardiology, Hospital Universitario A Coruña, As Xubias 84, 15006 A Coruña, Spain 

Corresponding author. Fax: +34 981 178 258.

Keywords : Hypertrophic cardiomyopathy, Left ventricular non-compaction, Contrast echocardiography

A 76-year-old man was admitted to hospital for a transient ischaemic attack. The electrocardiogram showed atrial fibrillation and biphasic T-waves in the precordial leads. Echocardiography disclosed severe asymmetrical apical hypertrophy with a typical ‘ace-of-spades’ configuration and a maximum left ventricular wall thickness of 21mm (Figure 1, Video 1). Although the apical myocardium appeared compact on two-dimensional echocardiography, colour Doppler revealed large linear flows at the left ventricular apex (Figure 2, Video 2), which broadened the differential diagnosis with deep apical recesses or left ventricular non-compaction. Contrast echocardiography was performed to further clarify the diagnosis, but failed to demonstrate any recesses within the apical myocardium (Figure 3, Video 3).

Figure 1

Figure 1. 

Echocardiography disclosing severe asymmetrical apical hypertrophy with a typical ‘ace-of-spades’ configuration.


Figure 2

Figure 2. 

Colour Doppler revealing large linear flows at the left ventricular apex.


Figure 3

Figure 3. 

Contrast echocardiography for opacification of the left ventricle failing to demonstrate any apical recesses.


Recent reports have shown that apical hypertrophic cardiomyopathy and left ventricular non-compaction may have overlapping phenotypes. Nonetheless, one must be aware of potential pitfalls in the differential diagnosis of these two entities. Severe apical hypertrophy may be accompanied by increased coronary blood flow to the hypertrophied segments, which may be misdiagnosed by colour Doppler as large recesses. In our case, colour Doppler showed typical diastolic flows from the epicardium to the endocardium, characteristic of intramyocardial coronary branches. Contrast echocardiography and cardiac magnetic resonance imaging may allow better delineation of the apical endocardium and, thus, may help to establish the correct diagnosis.

Conflict of interest


Appendix A. Supplementary data

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 Video 1 
Video 1. 

Echocardiography disclosing severe asymmetric apical hypertrophy with a typical ‘ace-of-spades’ configuration.

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 Video 2 
Video 2. 

Colour Doppler revealing large linear flows at the left ventricular apex.

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 Video 3 
Video 3. 

Contrast echocardiography for opacification of the left ventricle.

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