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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
PubMed

Insights

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.
Abstract

Keywords:
apical hypertrophic cardiomyopathyapical left ventricular aneurysmcardiac magnetic resonanceechocardiographyhypertrophic cardiomyopathyleft ventricular aneurysmleft ventricular obstructionpapillary muscles

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