title: Doppler Systolic Signal Void in Hypertrophic Cardiomyopathy: Apical Aneurysm and Severe Obstruction without Elevated Intraventricular Velocities.
abstract: BACKGROUND
  In patients with hypertrophic cardiomyopathy (HCM), akinetic apical aneurysms are associated with ventricular tachycardia, heart failure, apical thrombus, and mortality. The cause of apical aneurysms remains unresolved, and there is controversy about prevalence and significance of mid-left ventricular (LV) obstruction, often present in these patients. The aim of this study was to test the hypothesis that low velocities in patients with aneurysms are due to near complete cessation of mid-LV flow, characteristically marked by a Doppler signal void.
  
  
  METHODS
  This was a retrospective analysis of 39 patients with HCM with segmental hypertrophy of the mid left ventricle and complete systolic emptying at the mid-LV level. The severity of dynamic obstruction was evaluated by measuring the time during which cross-sectional mid-LV cavity area was <1 cm(2). Presence or absence of an LV Doppler midsystolic signal void was determined.
  
  
  RESULTS
  Akinetic apical aneurysms were present in 21 patients. The duration of two-dimensional mid-LV short-axis complete emptying was longer in patients with akinetic apical aneurysms (194 ± 45 vs 148 ± 63 msec, P = .013), nearly 50% of systole. Midsystolic signal voids were seen only in patients with akinetic apical aneurysms (P < .001), present in 86%. In patients with akinetic aneurysms, there was a strong correlation between the duration of the systolic signal void and the proportion of systole with complete emptying < 1 cm(2) (r = 0.704; P = .001). Complete emptying < 1 cm(2) for ≥ 38% of systole was associated with akinetic aneurysm (odds ratio, 9.35; P < .004).
  
  
  CONCLUSIONS
  Patients with akinetic apical aneurysm HCM have near complete cessation of flow across severe dynamic mid-LV obstruction for nearly 50% of systole. This explains how the adverse effects of obstruction may occur without high velocities on echocardiography.
authors.affiliation: Mount Sinai Roosevelt and Mount Sinai St. Luke's Hospitals, New York, New York.
authors.forename: Jose Ricardo F
authors.initials: JR
authors.lastname: Po
authors.affiliation: Mount Sinai Roosevelt and Mount Sinai St. Luke's Hospitals, New York, New York.
authors.forename: Bette
authors.initials: B
authors.lastname: Kim
authors.affiliation: Mount Sinai Roosevelt and Mount Sinai St. Luke's Hospitals, New York, New York.
authors.forename: Farhan
authors.initials: F
authors.lastname: Aslam
authors.affiliation: Mount Sinai Roosevelt and Mount Sinai St. Luke's Hospitals, New York, New York.
authors.forename: Milla
authors.initials: M
authors.lastname: Arabadjian
authors.affiliation: Mount Sinai Roosevelt and Mount Sinai St. Luke's Hospitals, New York, New York.
authors.forename: Glenda
authors.initials: G
authors.lastname: Winson
authors.affiliation: Mount Sinai Roosevelt and Mount Sinai St. Luke's Hospitals, New York, New York.
authors.forename: Deborah
authors.initials: D
authors.lastname: Cantales
authors.affiliation: Mount Sinai Roosevelt and Mount Sinai St. Luke's Hospitals, New York, New York.
authors.forename: Josef
authors.initials: J
authors.lastname: Kushner
authors.affiliation: Mount Sinai Roosevelt and Mount Sinai St. Luke's Hospitals, New York, New York.
authors.forename: Robert
authors.initials: R
authors.lastname: Kornberg
authors.affiliation: Mount Sinai Roosevelt and Mount Sinai St. Luke's Hospitals, New York, New York. Electronic address: mark.sherrid@nyumc.org.
authors.forename: Mark V
authors.initials: MV
authors.lastname: Sherrid
mesh_terms: D000368:Aged; D001783:Blood Flow Velocity; D002312:Cardiomyopathy, Hypertrophic / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology; D002423:Cause of Death / Q000639:trends; D003430:Cross-Sectional Studies; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006322:Heart Aneurysm / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014694:Ventricular Outflow Obstruction / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology
keywords: Apical aneurysm; Doppler echocardiography; Echocardiography; Hypertrophic cardiomyopathy; Obstructive hypertrophic cardiomyopathy