HCM patients with LV apical aneurysm have a largely unfavourable clinical course.
We present the first cohort of HCM patients with apical aneurysm and complete ECG follow-up (9 years).
HCM patients who develop apical aneurysm exhibit ECG changes during apical remodelling.
ECG alterations may raise the suspicion of apical aneurysm development in HCM patients.
Suggestive ECGs should prompt MRI and nonstandard echocardiographic views of LV apex.