Late systolic click in non-obstructive cardiomyopathy

Area of Science:

• Cardiology
• Cardiac Electrophysiology
• Cardiomyopathy Research

Background:

• Impaired left ventricular function can manifest with distinct auscultatory findings.
• Mitral regurgitation and abnormal left ventricular conduction are associated with cardiac dysfunction.
• Systolic clicks can provide diagnostic clues to underlying cardiac conditions.

Purpose of the Study:

• To report and analyze two cases of impaired left ventricular function presenting with very late systolic clicks.
• To explore potential mechanisms linking left ventricular dysfunction to the timing of systolic clicks.
• To differentiate these findings from cases with mid-systolic clicks and normal cardiac function.

Main Methods:

• Case report of two patients with detailed clinical evaluation.
• Electrocardiogram (ECG) analysis for left ventricular conduction abnormalities.
• Intraoperative assessment of mitral valve anatomy and left ventricular function.
• Correlation of clinical findings with cardiac mechanics and electrophysiology.

Main Results:

• Both patients exhibited severely impaired left ventricular function and abnormal ECG conduction.
• Mitral regurgitation was present, appearing secondary to left ventricular failure in one case.
• A very late systolic click was a consistent finding in both patients.
• Mitral valve annulus dilatation was noted in one patient during surgery.

Conclusions:

• Very late systolic clicks in the context of impaired left ventricular function may indicate significant cardiac pathology.
• The timing of these clicks could be attributed to increased left ventricular end-diastolic volume, impaired function, or abnormal ventricular activation.
• These findings highlight the importance of considering ventricular mechanics and electrophysiology in the interpretation of systolic clicks.