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Apical Aneurysms and Mid-Left Ventricular Obstruction in Hypertrophic Cardiomyopathy
Mark V Sherrid1, Samuel Bernard2, Nidhi Tripathi3
1Hypertrophic Cardiomyopathy Program, Leon Charney Division of Cardiology, New York University Langone Health, New York, New York, USA; Echocardiography Laboratory, New York University Langone Health, New York, New York, USA.
JACC. Cardiovascular Imaging
|January 21, 2023
Summary
Apical left ventricular aneurysms in hypertrophic cardiomyopathy are frequently associated with mid-left ventricular obstruction. This obstruction, characterized by complete systolic emptying, occurs in 95% of patients with these aneurysms.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Hypertrophic Cardiomyopathy Research
Background:
- Apical left ventricular (LV) aneurysms in hypertrophic cardiomyopathy (HCM) are linked to adverse clinical outcomes.
- The prevalence of mid-LV obstruction in HCM with apical aneurysms is highly variable in existing literature.
Purpose of the Study:
- To determine the precise frequency of mid-LV obstruction in patients presenting with apical aneurysms associated with HCM.
- To investigate the characteristics and implications of mid-LV obstruction in this patient cohort.
Main Methods:
- Analysis of echocardiographic and cardiac magnetic resonance imaging data from 108 patients with apical aneurysms.
- Comparison of these patients with normal controls and HCM patients without aneurysms.
- Assessment of mid-LV obstruction using Doppler imaging and evaluation of cardiac morphology.
Main Results:
- Mid-LV obstruction was identified in 95% of patients with apical aneurysms, often with complete systolic emptying.
- A midsystolic Doppler signal void, indicating flow cessation, was present in 84% of obstructed patients.
- Patients with aneurysms exhibited smaller short-axis (SAX) systolic areas and larger papillary muscle (PM) areas compared to controls.
Conclusions:
- The vast majority of patients with apical aneurysms in HCM exhibit associated mid-LV obstruction.
- Further investigation into the causal role of obstruction in the development of apical aneurysms is recommended.
Keywords:
apical hypertrophic cardiomyopathyapical left ventricular aneurysmcardiac magnetic resonanceechocardiographyhypertrophic cardiomyopathyleft ventricular aneurysmleft ventricular obstructionpapillary musclesMore Related Videos
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