Apical hypertrophic pseudocardiomyopathy: nosological problems

The classification of hypertrophic cardiomyopathies remains a thorny nosological problem. Within this extensive diagnostic group, it is felt that the very special sub-group of "Japanese" apical hypertrophic forms must be subject to the strictest possible criteria in order to avoid improper use. The case reported here of biventricular apical hypertrophic cardiomyopathy in a 60-year-old woman with a family history of HCM, in whom the clinical, ECG and above all angiographic features were typically those of AHCM but where the existence of an intraventricular gradient was found during challenge manoeuvres emphasises this classification problem. Pseudo-AHCM in a context of OCM or pseudo-OCM in a context of AHCM? The discussion is not merely of nosological interest in view of the recently documented clear prognostic differences between these two conditions. Main series from the literature are reviewed.