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Exercise Stress Echocardiography for Detection of Concealed Apical Pouch in Hypertrophic Cardiomyopathy

Sakiko Honda1, Michiyo Yamano1,2, Tomoko Sakaguchi3

  • 1Department of Cardiology, Matsushita Memorial Hospital, Osaka, Japan.

Echocardiography (Mount Kisco, N.Y.)
|August 4, 2025
PubMed

Insights

Diastolic paradoxical jet flow, an early sign of concealed apical pouches in hypertrophic cardiomyopathy, predicts adverse cardiovascular events. Exercise stress echocardiography can detect this flow even when cardiac MRI shows no pouch.

Area of Science:

  • Cardiovascular Medicine
  • Cardiology
  • Echocardiography

Background:

  • Hypertrophic cardiomyopathy (HCM) is a genetic heart muscle disease.
  • Adverse cardiovascular events are a significant concern in HCM patients.
  • Early detection of subtle hemodynamic changes is crucial for risk stratification.

Observation:

  • A specific diastolic flow pattern, termed diastolic paradoxical jet flow, originates from the left ventricular apex towards the base.
  • This flow is associated with the presence of a concealed apical pouch.
  • This finding is particularly relevant in the context of hypertrophic cardiomyopathy.

Findings:

  • Diastolic paradoxical jet flow is linked to an increased risk of adverse cardiovascular events in patients with hypertrophic cardiomyopathy.
  • Exercise stress echocardiography can effectively unmask this subtle flow pattern.
  • The flow may be detectable even when conventional imaging like cardiac magnetic resonance imaging (CMR) does not visualize an apical pouch.

Implications:

  • Exercise stress echocardiography offers a valuable tool for identifying patients at higher risk, even with negative structural imaging.
  • This finding may improve the diagnostic yield of echocardiography in hypertrophic cardiomyopathy.
  • Enhanced detection of concealed apical pouches could refine risk stratification and management strategies for HCM patients.

Keywords:
hypertrophic cardiomyopathyparadoxical jet flowstress echocardiography

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