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Hourglass appearance on ventriculography: insights from cardiac magnetic resonance imaging


Clinical introduction A 75-year-old patient with hypertension and severe aortic stenosis underwent elective coronary angiography that showed mild non-obstructive disease in the mid left anterior descending artery (LAD). A left ventriculogram, however, demonstrated segmental systolic dysfunction with dilated akinetic apex (figure 1A, see online supplementary video 1). There was no history of prior myocardial infarction and the patient had not experienced any chest pain recently. A 12-lead ECG showed widespread deep symmetrical inverted T-waves with the exception of leads I, aVL and V1 (see online supplementary figure S1). Cardiac MRI (CMR) was performed to further delineate the morphology of the left ventricle (LV) and a representative frame in late gadolinium phase is shown (figure 1B).

Question Above information is most likely consistent with:

  1. Takotsubo cardiomyopathy

  2. Left ventricular pseudoaneurysm

  3. Apical variant of hypertrophic cardiomyopathy (HCM) with aneurysm formation

  4. A sequel of prior myocardial infarction in the setting of aortic stenosis

  5. Left ventricular non-compaction

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