title: Increased intraventricular velocities: an unrecognized cause of systolic murmur in adults.
abstract: OBJECTIVE
  The purpose of this study was to determine the frequency, clinical features and echocardiographic characteristics of increased intraventricular velocities (IIVs) in patients referred to the echocardiography laboratory for systolic murmur.
  
  
  BACKGROUND
  A subset of patients referred to the echocardiography laboratory for evaluation of a systolic murmur have IIVs in the absence of other recognized causes of systolic murmur.
  
  
  METHODS
  We prospectively studied echocardiograms from 108 consecutive patients referred for evaluation of a systolic murmur. Clinical data were obtained from patient examinations and medical records.
  
  
  RESULTS
  The sole explanation for systolic murmur was IIVs in 16.7% of referred patients. Compared with those without IIVs, patients with IIVs had a higher ejection fraction (EF) (58.7+/-7.8% vs. 51.1+/-12.5%, p < 0.001), percent fractional shortening (42.3+/-9.7% vs. 31.0+/-11.4%, p < 0.0001), left ventricular (LV) mass index (181+/-70 vs. 152+/-48 g/m2, p=0.046) and prevalence of hypertension (73.3% vs. 51.7%, p=0.043) and a lower prevalence of segmental wall motion abnormalities (2.2% vs. 39.3%, p < 0.001).
  
  
  CONCLUSIONS
  Increased intraventricular velocities are a common cause of systolic murmur in this group of patients and should be included in the differential diagnosis of systolic murmurs in adults. The association of IIVs with LV hypertrophy should be a clinical consideration when these murmurs are identified.
authors.affiliation: Department of Medicine, Tucson Veterans Affairs Medical Center and University of Arizona 85723, USA.
authors.forename: P H
authors.initials: PH
authors.lastname: Spooner
authors.forename: M P
authors.initials: MP
authors.lastname: Perry
authors.forename: R O
authors.initials: RO
authors.lastname: Brandenburg
authors.forename: G D
authors.initials: GD
authors.lastname: Pennock
mesh_terms: D000368:Aged; D001314:Auscultation; D001783:Blood Flow Velocity / Q000502:physiology*; D003326:Coronary Circulation / Q000502:physiology*; D004452:Echocardiography; D015150:Echocardiography, Doppler; D005260:Female; D006337:Heart Murmurs / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D013599:Systole; D016276:Ventricular Function / Q000502:physiology*