case_images: PMC11748134_01
case_images: Baseline cardiac MRI. Diastolic, (A, C) and systolic phases, (B, D). Lack of basal to apical wall tapering, (C). Elevated mid to apical T1 mapping times (E). Admission ECG with poor R-wave progression, (F).
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case_images: In view of her electrocardiogram (ECG) raising concerns of an anterior non-ST elevation myocardial infarct (NSTEMI) (Figure 1F), together with elevated cardiac troponins, she was initially diagnosed as having an acute coronary syndrome (ACS). Incidentally, the cMRI showed morphological features consistent with apical HCM (Figure 1).
case_images: Cardiac MRI at 3 months. Resolution of the apical wall thickening, (A, C) diastole, (B. D) systole. T1 mapping times show ongoing elevation of T1times in the apex compared to the base, (E). Evolving ECG changes mimicking apical hypertrophic cardiomyopathy criteria, (F).
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case_images: Subsequent cMRI (Figure 2), did not demonstrate any focal LGE, but persistently elevated T1 times 1204 ms in the mid-septum and 1293 ms in the apical septal wall.
case_images: Cardiac MRI at 15 months. Complete resolution of apical wall thickening, (A, C) diastole, (B, D) systole. Resolving T1 times, (E) and persisting T-waves changes (F).
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case_images: Due to the discrepancy between the two initial cMRI investigations, a further cMRI examination was requested, which took place 15 months after her index presentation (Figure 3).