Objective Apical hypertrophic cardiomyopathy (HCM) is characterised by apical systolic obliteration and is associated with atrial fibrillation (AF), stroke, heart failure (HF), and mortality. We investigated whether apical obliteration of the left ventricular (LV) cavity could have an unfavourable impact on the clinical course of apical HCM. Methods 188 patients with apical HCM (114 males, median age 67 years) were identified retrospectively from January 2008 to December 2010. The rate of apical obliteration was defined as the net obliteration to end-diastolic apical cap thickness, and the ratio of obliteration to cavity was defined as the end-systolic obliteration to cavity height. Events were defined as a composite of new onset of AF, stroke, HF, and cardiovascular (CV) death. Results There were 43 clinical events (19 AFs, 11 HFs, 9 strokes, and 4 deaths) during a follow-up of median 4.4 years. The events patients were older, had larger left atrial volume index (LAVI), lower late diastolic mitral annular tissue Doppler velocity (a′), and higher LV end-diastolic pressure (E/e′). They had greater apical thickness and obliteration, smaller systolic cavity height, higher rate of obliteration, and higher ratio of obliteration to cavity; events were significantly higher (54%) in the upper tertiles of the ratio of obliteration to cavity. Age, E/e′, a′, LAVI, apical thickness, rate of obliteration, and ratio of obliteration to cavity were associated with events. On multivariable analysis, the ratio of obliteration to cavity remained a significant predictor. Conclusions The ratio of obliteration to cavity could provide useful information to predict the occurrence of adverse events in apical HCM.

Kim IC, et al. J Korean Med Sci. 2020 Sep;35(39):e349. https://doi.org/10.3346/jkms.2020.35.e349

Backgrounds: We aimed to understand the association between initial vestibular function examination and postural instability (PI) development in Parkinson’s disease (PD). Methods: After screening 51 PD patients, we divided 31 patients into 2 groups based on the presence of PI at the follow-up visit and compared the clinical features and vestibular-evoked myogenic potential (VEMP) variables. Results: The mean values of Hoehn and Yahr stage, Unified Parkinson’s Disease Rating Scale (UPDRS) part III, and item 30 (postural stability) of UPDRS were larger in patients with PI at a follow-up visit (p = 0.000, 0.006, 0.048, respectively). In VEMP analyses, the onset latencies of left and right cervical VEMPs were significantly reduced in patients with PI (p = 0.013, 0.040, respectively). Conclusion: We found that the initial VEMP test may be associated with later postural imbalance in PD, suggesting the baseline evaluation may help predict future PI occurrence. A more significant number of patients and more long-term follow-ups are likely to be required for confirmation.

Human gait inevitably deteriorates with "physiologic" aging as well as age-related pathologic conditions particularly in the older adults. However, some of them maintain relatively normal gait pattern well into their 80s. The existence of "successful aging" group in terms of gait performance suggests that senile gait is no more a consequence of aging alone. Here, we discuss age-related change of gait to characterize gait in the elderly, and briefly review the classification system of gait disorders in the elderly.