Apical aneurysm or transient apical ballooning? Potential dilemma in risk stratification of hypertrophic cardiomyopathy

To the Editor

Left ventricular apical aneurysm (LVAA) formation in the setting of hypertrophic cardiomyopathy (HCM) usually appears to be associated with a significant midventricular obstruction and is potentially associated with adverse cardiovascular events.1 In their recently published article,1 Ramchand et al have suggested LVAA as a major risk marker in this setting. Though we fully agree with the authors on this point, we would like to draw attention to certain other conditions, including transient left ventricular apical ballooning that might strongly mimick LVAA, leading to a potential misdiagnosis in patients with HCM.

Takotsubo cardiomyopathy (TTC) presenting with a transient apical ballooning pattern has been recently suggested to have a pure mechanical basis in certain patients with pre-existing structural heart disease, including hypertensive heart disease and HCM, largely attributable to acute increments in intraventricular pressure gradient leading to substantially elevated apical wall stress in these…

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