Progressive Myocardial Fibrosis in a Patient With Apical Hypertrophic Cardiomyopathy Detected by Cardiovascular Magnetic Resonance

A 60-year-old white man initially presented to the outpatient clinic in 2002 complaining of atypical chest pain during the last 6 months. A resting ECG showed high R waves and giant negative T waves in the anterior leads (Figure). Cardiovascular magnetic resonance (CMR) showed the typical appearance of apical hypertrophic cardiomyopathy (Figure, A and B). Delayed enhancement imaging did not show relevant scar tissue during the baseline study (Figure, C and D). The patient was put on a β-blocker and an angiotensin-converting enzyme inhibitor and was asked to come back for a follow-up examination 2 years later. Left, …