Left ventricular (LV) endomyocardial calcification is very rarely observed in apical hypertrophic
cardiomyopathy (HCM). We report 4 cases of apical hypertrophic cardiomyopathy with LV
endomyocardial calcification. They were 60-year-old man, 58-year-old man, 48-year-old woman,
and 53-year-old man.They had only mild and infrequent cardiac symptoms; palpitation in 3, chest
pain in 2, dyspnea in 2. None had a clinical evidence of systemic thromboembolism. Surface
electrocardiogram showed typical findings of apical HCM; LV hypertrophy with strain and deep
inversion of T waves in the left precordial leads. Two-dimensional echocardiogram revealed
markedly thickened LV apex and highly-echogenic linear densities scattered along the endocardial
surface of LV apex in all 4 cases. In Case 1 and 2, fluoroscopy revealed endomyocardial
calcification in the LV apex and LV angiogram showed globular shaped LV cavities. In Case 2 and
3, eosinophil counts in peripheral blood were 1,180 and 1,400/mm3 restrictively. Endomyocardial
biopsy disclosed multiple vacuolar degeneration of myocytes and mild interstitial fibrosis without
infiltration of inflammatory cells in Case 2. In conclusion, we report 4 cases of apical HCM with LV
endomyocardial calcification. The presenting symptoms were usually mild. Typical electrocardiographic and echocardiographic features of apical HCM were very useful in making a diagnosis.
Clinical significance of endomyocardial calcification in apical HCM needs to be verified.