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In Reply: Dr Refaat inquires about the small morphologic subset (approximately 3% of patients with HCM) in whom mild hypertrophy is confined to the most distal portion of the left ventricular chamber. Of our 506 study patients, we are aware of only 2 high-risk participants who could be considered to have the apical form of HCM (neither of whom received an appropriate shock). This probably reflects the low-risk status of many patients within this morphologic subgroup.^1-4 Of note, those patients with HCM in the study cohort who did experience appropriate shocks for life-threatening ventricular tachycardia or fibrillation had substantial left ventricular hypertrophy (mean wall thickness, 23 [SD, 6] mm, compared with the thicknesses of 16-20 mm that are usual for localized apical hypertrophy^{3, 5}).

However, we disagree with Refaat's suggestion that apical hypertrophy is a distinct disease entity. Apical HCM is characterized by generally mild left ventricular hypertrophy and in . . . [Full Text of this Article]

Barry J. Maron, MD
hcm.maron@mhif.org
Minneapolis Heart Institute Foundation
Minneapolis, Minnesota

Paolo Spirito, MD
Ente Ospedaliero Ospedali Galliera
Genoa, Italy

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