| Sumario: | Background: Left ventricular (LV) apical aneurysms (ApAn+) occur in 10%–15% of apical hypertrophic cardiomyopathy (ApHCM) patients and confer considerable morbidity. We hypothesized that ApAn+ adversely impact ventricular mechanics and mechano‐energetic coupling in ApHCM. Methods: Ninety‐eight ApHCM patients were identified, of which nine (9%) had ApAn+ and were compared with 89 (91%) who did not (ApAn−). 2D speckle‐tracking echocardiography assessed ventricular mechanics using LV global longitudinal strain (GLS) and torsion, and mechano‐energetic coupling as myocardial work indices. Clinical events over follow‐up were adjudicated. Results: Mean age was 64 ± 15 years, 46% were female, and 3% had an HCM family history, with similar clinical risk factors between groups. Of the nine ApAn+ patients, there were six small (<2 cm) and three moderate‐sized (2‐4 cm) aneurysms. There was no difference in LV ejection fraction (65 ± 15 vs. 67 ± 11%, p = 0.51) or GLS (−9.6 ± 3.3 vs. −11.9 ± 3.9%, p = 0.09) between ApAn+ versus ApAn−. ApAn+ patients had greater myocardial global wasted work (347 ± 112 vs. 221 ± 165 mmHg%, p = 0.03) and lower global work efficiency (GWE, 75 ± 5 vs. 82 ± 8%, p = 0.006). LV GLS (β = −0.67, p < 0.001), ApAn+ (β = −0.15, p = 0.04), and twist rate (β = −0.14, p = 0.04) were independently associated with GWE. At 3.9‐year follow‐up, cardiovascular mortality (4%) and heart failure hospitalization (14%) events were similar between groups. Conclusion: ApHCM patients with ApAn+ are characterized by more impaired LV mechano‐energetic coupling when compared with ApAn−. ApAn+ is independently associated with worse GWE.
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