Occurrence of Left Ventricular Cavity Obliteration

Left ventricular cavity obliteration (LVCO) is an echocardiographic phenomenon characterized by near-complete systolic apposition of the ventricular walls with associated intracavitary flow acceleration and gradient formation. Although often discussed in relation to hypertrophic phenotypes, its clinical profile and diagnostic spectrum among patients with left ventricular (LV) intracavitary gradients remain insufficiently described. This study evaluated the occurrence and echocardiographic predictors of LVCO in patients with Doppler-detected LV cavity gradients.

This hospital-based prospective observational cross-sectional study was conducted in the Department of Cardiology at Meenakshi Medical College Hospital and Research Institute, Kanchipuram, India, from November 2024 to December 2025. Sixty consecutive adults with a peak Doppler LV intracavitary gradient of at least 30 mmHg on transthoracic echocardiography were included. LVCO was defined using integrated two-dimensional and Doppler criteria. Associations with diagnostic category were assessed using the Pearson chi-square test, cavity size differences using the independent-samples t-test, and predictors of LVCO using binary logistic regression.

The mean age of the cohort was 48.87 ± 18.88 years; 25 patients (41.7%) were male and 35 (58.3%) were female. LVCO was present in 31 of 60 patients (51.7%). Dilated cardiomyopathy was the most frequent diagnosis overall (20/60, 33.3%), followed by hypertrophic obstructive cardiomyopathy (17/60, 28.3%). The distribution of diagnostic categories did not differ significantly according to LVCO status (χ²(3) = 3.90, p = 0.272). Among 50 patients with available cavity measurements, mean LV cavity size was comparable between groups (37.39 ± 0.67 mm vs 37.18 ± 0.81 mm; t(48) = 1.00, p = 0.323). On logistic regression, hypertension showed a non-significant trend toward higher odds of LVCO (odds ratio [OR] 5.30, 95% confidence interval [CI] 0.97-29.0, p = 0.054), whereas the peak baseline LV gradient showed a statistically significant but modest inverse association with LVCO (OR 0.97 per 1 mmHg increase, 95% CI 0.94-0.99, p = 0.030). The model showed acceptable apparent discrimination and calibration within the study sample, with an area under the curve of 0.80, Hosmer-Lemeshow statistic of 6.20 (p = 0.61), and Nagelkerke R² of 0.32; however, the discriminative estimate may be optimistic given the modest sample size and lack of validation.

LVCO was a frequent finding in patients with echocardiographic LV intracavitary gradients but was not significantly associated with a single diagnostic category. These findings suggest that, in this selected hospital-based cohort of patients with measurable intracavitary gradients, LVCO may be better interpreted as a dynamic hemodynamic pattern rather than a diagnosis-specific marker; however, this inference should be considered preliminary and hypothesis-generating.