Relation Between Early Diastolic Mid-Ventricular Flow and Elastic Forces Indicating Aneurysm Formation in Hypertrophic Cardiomyopathy - 03/08/22
, Roy Huurman, MD a, Daniel J. Bowen, BSc a, Arend F.L. Schinkel, MD, PhD a, Alexander Hirsch, MD, PhD b, Michelle Michels, MD, PhD aAbstract |
Background |
The early diastolic paradoxical midventricular flow is suggestive of apical aneurysm (AA) formation in hypertrophic cardiomyopathy (HCM). We aimed to determine whether early diastolic paradoxical midventricular flow may be a useful screening tool in patients, following the time progression of HCM to the aneurysmal stage.
Methods |
One hundred twenty-one HCM patients with dominant hypertrophy in the mid and apical segments, based on echocardiography and/or cardiovascular magnetic resonance, were selected from our HCM database, which comprises 1,332 patients. They were further stratified according to the presence of AA. All imaging studies in a period of 16 years (2005-2021) were considered for time progression. Midventricular Doppler (pulsed-wave, continuous-wave, color, and color M mode) were analyzed.
Results |
Thirty-five patients (29% of the study group and 2.6% of all HCM patients) had AA. Early diastolic paradoxical midventricular flow had a sensitivity of 92% and specificity of 98.6% for the detection of AA in the study group. In 108 patients, follow-up echocardiography was performed (median, 5 [3-9] studies). Sixteen patients (15%) with 10 [7-12] years of follow-up displayed progressive time changes in left ventricle (LV) apical morphology and/or mid-LV flow. Ten patients (9%) progressed to an AA, during 7 [4-11] years of follow-up. Patients progressing to AA were younger (P = .009), with more severe LV hypertrophy (P = .01) and more often a significant mid-LV systolic gradient (≥30 mm Hg, P < .001). A wall thickness over 20 mm had 70% sensitivity and 69% specificity in detecting evolution toward AA. With significant systolic gradient, sensitivity was 80% and specificity was 62%. Furthermore, patients with AA had a higher incidence of ventricular tachycardia (log-rank P = .03).
Conclusions |
Early diastolic paradoxical midventricular flow reliably detects AA presence and should prompt extra imaging studies. In HCM with mid and apical dominant involvement there is a progressive trend toward aneurysm formation, especially in patients with wall thickness over 20 mm and significant mid-LV systolic gradient (≥30 mm Hg), which can be monitored through serial Doppler studies.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Mid-LV EDF is a reliable marker of aneurysm in HCM. |
• | There is a trend of progression from a hyperkinetic apex to AA. |
• | Progressing patients have more severe hypertrophy and mid-LV gradient. |
• | Abnormal mid-LV early diastolic flow should raise awareness of aneurysm presence. |
Keywords : Hypertrophic cardiomyopathy, Early diastolic paradoxical flow, Apical aneurysm
Abbreviations : 2D, AA, CMR, CW, EDF, ER, FIESTA, HCM, ICD, IQR, LV, LVEF, LVOT, PW, VT
Plan
| Conflicts of Interest: None. |
Vol 35 - N° 8
P. 846 - août 2022 Retour au numéro
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