Diastolic paradoxic jet flow in patients with hypertrophic cardiomyopathy: evidence of concealed apical asynergy with cavity obliteration

Second Department of Medicine, Kyoto Prefectural University of Medicine, Japan.

In 20 of 198 patients with hypertrophic cardiomyopathy, Doppler color flow imaging revealed diastolic paradoxic jet flow across the obliterated left ventricular apex toward the base that suggested the presence of a discrete apical chamber. This prospective study characterized echocardiographic, ventriculographic and scintigraphic findings in these patients, as well as their clinical features. Although echocardiography did not directly show the apical chamber in 13 of the 20 patients, left ventriculography always revealed a small apical outpouching separated from the major basal cavity. Systolic bulging of the apex was always followed by early diastolic shrinkage together with persistent cavity narrowing between the two chambers. After the systolic jet flow, the paradoxic jet flow lasted for 366 +/- 160 ms after aortic valve closure and always extended into the diastolic filling period. The maximal velocity of the paradoxic jet flow occurred during isovolumetric relaxation and the mean velocity was 2 +/- 0.8 m/s, indicating a higher diastolic pressure in the apical chamber than in the main ventricle. Compared with patients who manifested cavity obliteration alone, patients with a paradoxic jet flow more often developed systemic embolism (p less than 0.01), ventricular tachycardia (p less than 0.05) and thallium perfusion abnormalities localized to the apical region (p less than 0.01). Thus, paradoxic jet flow could be an important marker of concealed apical asynergy and the risk of adverse clinical events. The higher diastolic apical pressure suggested by the flow may contribute to the development of an apical aneurysm, even in the absence of fixed coronary artery disease.

This article has been cited by other articles:

				Y. Minami, K. Kajimoto, Y. Terajima, B. Yashiro, D. Okayama, S. Haruki, T. Nakajima, N. Kawashiro, M. Kawana, and N. Hagiwara Clinical Implications of Midventricular Obstruction in Patients With Hypertrophic Cardiomyopathy J. Am. Coll. Cardiol., June 7, 2011; 57(23): 2346 - 2355. [Abstract] [Full Text] [PDF]

				S. P. Goldberg, C. J. Knott-Craig, U. S. Boston, G. C. Mari, E. V. Colvin, and T. K. Chin Surgical Management of Unusual Cardiac Tumors in Infants and Children World Journal for Pediatric and Congenital Heart Surgery, July 1, 2010; 1(2): 211 - 216. [Abstract] [Full Text] [PDF]

				M. V. Sherrid, O. Wever-Pinzon, A. Shah, and F. A. Chaudhry Reflections of Inflections in Hypertrophic Cardiomyopathy J. Am. Coll. Cardiol., July 14, 2009; 54(3): 212 - 219. [Abstract] [Full Text] [PDF]

				M. S. Maron, J. J. Finley, J. M. Bos, T. H. Hauser, W. J. Manning, T. S. Haas, J. R. Lesser, J. E. Udelson, M. J. Ackerman, and B. J. Maron Prevalence, Clinical Significance, and Natural History of Left Ventricular Apical Aneurysms in Hypertrophic Cardiomyopathy Circulation, October 7, 2008; 118(15): 1541 - 1549. [Abstract] [Full Text] [PDF]

				I. Olivotto, M. S. Maron, A. S. Adabag, S. A. Casey, D. Vargiu, M. S. Link, J. E. Udelson, F. Cecchi, and B. J. Maron Gender-Related Differences in the Clinical Presentation and Outcome of Hypertrophic Cardiomyopathy J. Am. Coll. Cardiol., August 2, 2005; 46(3): 480 - 487. [Abstract] [Full Text] [PDF]

				K. Matsubara, T. Nakamura, T. Kuribayashi, A. Azuma, and M. Nakagawa Sustained cavity obliteration and apical aneurysm formation in apical hypertrophic cardiomyopathy J. Am. Coll. Cardiol., July 16, 2003; 42(2): 288 - 295. [Abstract] [Full Text] [PDF]

				M. V. Sherrid, F. A. Chaudhry, and D. G. Swistel Obstructive hypertrophic cardiomyopathy: echocardiography, pathophysiology, and the continuing evolution of surgery for obstruction Ann. Thorac. Surg., February 1, 2003; 75(2): 620 - 632. [Abstract] [Full Text] [PDF]