title: Diastolic paradoxic jet flow in patients with hypertrophic cardiomyopathy: evidence of concealed apical asynergy with cavity obliteration.
abstract: 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.
authors.affiliation: Second Department of Medicine, Kyoto Prefectural University of Medicine, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Nakamura
authors.forename: K
authors.initials: K
authors.lastname: Matsubara
authors.forename: K
authors.initials: K
authors.lastname: Furukawa
authors.forename: A
authors.initials: A
authors.lastname: Azuma
authors.forename: H
authors.initials: H
authors.lastname: Sugihara
authors.forename: H
authors.initials: H
authors.lastname: Katsume
authors.forename: M
authors.initials: M
authors.lastname: Nakagawa
mesh_terms: D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity; D001794:Blood Pressure; D002312:Cardiomyopathy, Hypertrophic / Q000000981:diagnostic imaging / Q000503:physiopathology*; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D005260:Female; D015637:Gated Blood-Pool Imaging; D006321:Heart / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006322:Heart Aneurysm / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology; D011446:Prospective Studies; D013318:Stroke Volume; D014055:Tomography, Emission-Computed; D016277:Ventricular Function, Left / Q000502:physiology*; D014694:Ventricular Outflow Obstruction / Q000209:etiology / Q000503:physiopathology