I read with interest the report by Chung et al, who presented a case series of predominantly Caucasian elderly Australians with apical hypertrophic cardiomyopathy (HC). Almost 3 decades ago, Steingo et al from South Africa and my group reported the first cases of apical HC from outside Japan. Chia and Tan from Singapore confirmed our comments regarding the fact that the Japanese form of apical HC described outside Japan is very different from Maron et al’s cases of HC with septal hypertrophy localized to the apex.

In a long-term follow-up study of series of patients with apical HC, we highlighted the fact that the disease is not as benign as it was thought, and morphologic and electrocardiographic changes with life-threatening ventricular arrhythmias may appear, culminating in the implantation of an internal defibrillator. Atrial fibrillation occurred in 18% of our patients, compared to 31% in Chung et al’s study. This may be related to the higher mean age of 71 years, compared to 57 years in our report. We noted that complications and changes in voltage and T-wave negativity and apical aneurysmatic formation tended to appear at extended follow-up beyond 10 years. With the ongoing increase in the use of new imaging modalities such as nuclear magnetic resonance, more apical aneurysms will be revealed.

Although we disagree with the investigators’ claim that their case series was the first characterizing apical HC in an elderly non-Japanese population, we do agree with their conclusions and commend them on their contribution.