Size Matters. Prevalence and Clinical Implications of Left Ventricular Apical Aneurysms in Hypertrophic Cardiomyopathy: A Systematic Review and Meta-Analysis.

Background: The aim of this study was to systematically review the recently published literature and determine the prevalence of left ventricular apical aneurysm (LVAA) formation in hypertrophic cardiomyopathy and its association with sudden cardiac death, systemic embolization, and heart failure.

Methods: The protocol was registered with the International Prospective Register of Systematic Reviews (registration number: CRD42023453640). MEDLINE and manual searches for articles published up to August 2023 were performed. Longitudinal, observational cohorts of unselected adult patients with hypertrophic cardiomyopathy were considered. Data were pooled using a random-effects model.

Results: A total of 321 articles fulfilled the search criteria, and 10 retrospective observational studies were selected for the meta-analysis. The pooled prevalence of LVAA was 3% (95% CI, 2%-5%), and 57% of LVAAs were small (<2 cm). Small LVAAs had a lower prevalence of sudden cardiac death end points (4.71% [95% CI, 1.5%-9%) than bigger (≥2 cm) LVAAs (22% [95% CI, 15%-31%), with an odds ratio of 4.65 (95% CI, 2.14-10.10). The prevalence of systemic emboli was also higher in bigger LVAAs (17% [95% CI, 9%-28%) when compared with small LVAA (9% [95% CI, 4%-16%), with an odds ratio of 1.78 (95% CI, 0.53-5.99). Left ventricular thrombi were also more frequently detected in bigger LVAAs (30% [95% CI, 20%-42%) than small LVAAs (2% [95% CI, 0%-6%), with an odds ratio of 10.92 (95% CI, 3.75-31.84). There are scant data on heart failure deaths.

Conclusions: The available data suggest that patients with bigger LVAAs (>2 cm) have the highest risk of poor outcomes and could be preferentially targeted for primary prevention of sudden cardiac death and systemic embolization.