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Yamaguchi syndrome: a rare type of hypertrophic cardiomyopathy

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Published: 9 October 2025
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Apical hypertrophic cardiomyopathy, also known as Yamaguchi syndrome, is a rare variant of hypertrophic cardiomyopathy characterized by thickening of the apical segment of the left ventricle. Due to its non-specific symptoms and the limitations of standard echocardiography, it often remains undiagnosed. This article summarizes current literature regarding the epidemiology, pathophysiology, diagnosis, management, and prognosis of Yamaguchi syndrome. A narrative literature review was conducted using PubMed, Scopus, Web of Science, UpToDate, and European Society of Cardiology guidelines, analyzing studies published between 2016 and 2024, with emphasis on clinical presentation, imaging techniques, and risk assessment for sudden cardiac death. The syndrome is more common in Asian populations and is rarely reported in Europe and the Balkans. Electrocardiography typically reveals deep negative T waves in precordial leads, while cardiac magnetic resonance imaging remains the most accurate diagnostic method. Although the overall prognosis is generally favorable, some patients remain at risk for sudden cardiac death, particularly those with documented fibrotic involvement identified by late gadolinium enhancement. Management is usually conservative, with periodic follow-up and individualized decisions regarding the implantation of an implantable cardioverter defibrillator. Raising awareness of this rare variant, particularly in the Balkan region, is essential for timely diagnosis and optimal management.

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Maron BJ, Ommen SR, Semsarian C, et al. Hypertrophic cardiomyopathy: present and future, with translation into contemporary cardiovascular medicine. J Am Coll Cardiol 2014;64:83-99. DOI: https://doi.org/10.1016/j.jacc.2014.05.003
Yamaguchi H, Ishimura T, Nishiyama S, et al. Hypertrophic nonobstructive cardiomyopathy with giant negative T waves (apical hypertrophy): ventriculographic and echocardiographic features in 30 patients. Am J Cardiol 1979;44:401-12. DOI: https://doi.org/10.1016/0002-9149(79)90388-6
Eriksson MJ, Sonnenberg B, Woo A, et al. Long-term outcome in patients with apical hypertrophic cardiomyopathy. J Am Coll Cardiol 2002;39:638-45. DOI: https://doi.org/10.1016/S0735-1097(01)01778-8
Hughes RK, Knott KD, Malcolmson J, et al. Apical hypertrophic cardiomyopathy: the variant less known. J Am Heart Assoc 2020;9:e015294. DOI: https://doi.org/10.1161/JAHA.119.015294
Kitaoka H, Doi Y, Casey SA, et al. Comparison of prevalence of apical hypertrophic cardiomyopathy in Japan and the United States. Am J Cardiol 2003;92:1183-6. DOI: https://doi.org/10.1016/j.amjcard.2003.07.027
Klarich KW, Attenhofer Jost CH, Binder J, et al. Risk of death in long-term follow-up of patients with apical hypertrophic cardiomyopathy. Am J Cardiol 2013;111:1784-91. Erratum in: Am J Cardiol 2013;112:1271. DOI: https://doi.org/10.1016/j.amjcard.2013.08.006
Valente AM, Lakdawala NK, Powell AJ, et al. Comparison of echocardiographic and cardiac magnetic resonance imaging in hypertrophic cardiomyopathy sarcomere mutation carriers without left ventricular hypertrophy. Circ Cardiovasc Genet 2013;6:230-7. DOI: https://doi.org/10.1161/CIRCGENETICS.113.000037
O’Hanlon R, Grasso A, Roughton M, et al. Prognostic significance of myocardial fibrosis in hypertrophic cardiomyopathy. J Am Coll Cardiol 2010;56:867-74. DOI: https://doi.org/10.1016/j.jacc.2010.05.010
Satoh H, Sano M, Suwa K, et al. Distribution of late gadolinium enhancement in various types of cardiomyopathies: significance in differential diagnosis, clinical features and prognosis. World J Cardiol 2014;6:585-601. DOI: https://doi.org/10.4330/wjc.v6.i7.585
Flett AS, Maestrini V, Milliken D, et al. Diagnosis of apical hypertrophic cardiomyopathy: T-wave inversion and relative but not absolute apical left ventricular hypertrophy. Int J Cardiol 2015;183:143-8. DOI: https://doi.org/10.1016/j.ijcard.2015.01.054
Ho CY, López B, Coelho-Filho OR, et al. Myocardial fibrosis as an early manifestation of hypertrophic cardiomyopathy. N Engl J Med 2010;363:552-63. DOI: https://doi.org/10.1056/NEJMoa1002659
Li J, Fang J, Liu Y, Wei X. Apical hypertrophic cardiomyopathy: pathophysiology, diagnosis and management. Clin Res Cardiol 2024;113:680-93. DOI: https://doi.org/10.1007/s00392-023-02328-8
Sakamoto T, Tei C, Murayama M, et al. Giant T wave inversion as a manifestation of asymmetrical apical hypertrophy of the left ventricle. Jpn Heart J 1976;17:611-29. DOI: https://doi.org/10.1536/ihj.17.611
Garg L, Gupta M, Sabzwari SR, et al. Atrial fibrillation in hypertrophic cardiomyopathy: prevalence, clinical impact, and management. Heart Fail Rev 2019;24:189-97. DOI: https://doi.org/10.1007/s10741-018-9752-6
Paluszkiewicz J, Krasinska B, Milting H, et al. Apical hypertrophic cardiomyopathy: diagnosis, medical and surgical treatment. Kardiochir Torakochirurgia Pol 2018;15:246-53. DOI: https://doi.org/10.5114/kitp.2018.80922
Park YM, Jang AY, Chung WJ, et al. Ventricular fibrillation and sudden cardiac arrest in apical hypertrophic cardiomyopathy: two case reports. World J Clin Cases 2021;9:11102-7. DOI: https://doi.org/10.12998/wjcc.v9.i35.11102
Kissopoulou A, Ellegård R, Fernlund EI, et al. Unravelling the genotype of the apical variant of hypertrophic cardiomyopathy in a Swedish cohort. Genes 2025;16:494. DOI: https://doi.org/10.3390/genes16050494
Hajj-Ali A, Gaballa A, Akintoye E, et al. Long-term outcomes of patients with apical hypertrophic cardiomyopathy utilizing a new risk score. JACC Adv 2024;3:101235. DOI: https://doi.org/10.1016/j.jacadv.2024.101235
Arbelo E, Protonotarios A, Gimeno JR, et al. 2023 ESC Guidelines for the management of cardiomyopathies. Eur Heart J 2023;44:3503-626. DOI: https://doi.org/10.1093/eurheartj/ehad194
Tao Y, Xu J, Bako SY, et al. Usefulness of ECG to differentiate apical hypertrophic cardiomyopathy from non-ST elevation acute coronary syndrome. BMC Cardiovasc Disord 2020;20:306. DOI: https://doi.org/10.1186/s12872-020-01592-0
Maron MS, Rowin EJ, Maron BJ. How to image hypertrophic cardiomyopathy. Circ Cardiovasc Imaging 2017;10:e005372. DOI: https://doi.org/10.1161/CIRCIMAGING.116.005372
Parato VM, Antoncecchi V, Sozzi F, et al. Echocardiographic diagnosis of the different phenotypes of hypertrophic cardiomyopathy. Cardiovasc Ultrasound 2015;14:30. DOI: https://doi.org/10.1186/s12947-016-0072-5
Kim KH, Kim HK, Hwang IC, et al. Myocardial scarring on cardiovascular magnetic resonance in asymptomatic or minimally symptomatic patients with “pure” apical hypertrophic cardiomyopathy. J Cardiovasc Magn Reson 2012;14:52. DOI: https://doi.org/10.1186/1532-429X-14-52
Nagueh SF, Bierig SM, Budoff MJ, et al. Recommendations for multimodality cardiovascular imaging of patients with hypertrophic cardiomyopathy: an update from the American Society of Echocardiography, the American Society of Nuclear Cardiology, Society for Cardiovascular Magnetic Resonance, and Society of Cardiovascular Computed Tomography. J Am Soc Echocardiogr 2022;35:533-69. DOI: https://doi.org/10.1016/j.echo.2022.03.012
Spirito P, Autore C. Apical hypertrophic cardiomyopathy or left ventricular non compaction? A difficult differential diagnosis. Eur Heart J 2007;28:1923-4. DOI: https://doi.org/10.1093/eurheartj/ehm266
Ommen SR, Mital S, Burke MA, et al. 2020 AHA/ACC guideline for the diagnosis and treatment of patients with hypertrophic cardiomyopathy. J Am Coll Cardiol 2020;76:e159-240. DOI: https://doi.org/10.1016/j.jacc.2020.08.045
Chan RH, Maron BJ, Olivotto I, et al. Prognostic value of quantitative contrast-enhanced cardiovascular magnetic resonance for the evaluation of sudden death risk in patients with hypertrophic cardiomyopathy. Circulation 2014;130:484-95. DOI: https://doi.org/10.1161/CIRCULATIONAHA.113.007094
Guo M, Liu C, Ye J, Liu J. Clinical characteristics and long-term outcomes in patients with apical hypertrophic cardiomyopathy. ESC Heart Fail 2025;12:2887-97. DOI: https://doi.org/10.1002/ehf2.15298
Elliott PM, Anastasakis A, Borger MA, et al. 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy. Eur Heart J 2014;35:2733-79. DOI: https://doi.org/10.1093/eurheartj/ehu284
Lee JV, Emmanuela M, Patricio A, et al. Systematic review and meta-analysis comparing long-term outcomes in apical versus nonapical hypertrophic cardiomyopathy. Am J Cardiol 2025;194:94-100. DOI: https://doi.org/10.1016/j.amjcard.2025.08.005
Chen QF, Zou J, Katsouras CS, et al. Clinical characteristics and outcomes in patients with apical and nonapical hypertrophic cardiomyopathy. J Am Heart Assoc 2024;13:e036663. DOI: https://doi.org/10.1161/JAHA.124.036663

How to Cite



Yamaguchi syndrome: a rare type of hypertrophic cardiomyopathy. (2025). Italian Journal of Medicine, 19(4). https://doi.org/10.4081/itjm.2025.2133