P695Apically displaced papillary muscles mimicking apical hypertrophic cardiomyopathy

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Background: Although apical hypertrophic cardiomyopathy (ApHCM) is characterized by giant negative T (GNT) wave on electrocardiogram (ECG) and apical hypertrophy on echocardiogram, whether presence of these two findings is specific for ApHCM is largely unknown.Methods: By retrospective collection of 12-lead ECG with GNT and apical hypertrophy on 2D-echocardiogram from 2008 to 2010, we identified 55 patients with both of these findings. GNT was defined as negative T wave of at least 10mm in any precordial leads. Apically displaced papillary muscle was defined as displaced anterolateral papillary muscle to the apical 1/3 of the left ventricle. ApHCM was diagnosed otherwise.Results: Careful evaluation of the 2D-echocardiogram suggested that approximately 20% (11/55) of the total patients had apically displaced papillary muscle (ADPM) mimicking ApHCM. The baseline clinical and echocardiography data were not different between the two, suggesting that the discrimination between the two may be subtle and difficult. In addition, patients with ADPM frequently showed abnormal insertion of the papillary muscle into either left ventricular outflow tract or base of mitral valve leaflet.Conclusions: Apically displaced papillary muscle may mimic ApHCM, and whether this entity is a subtype of ApHCM or a normal variant warrants further investigation.

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