Apical Aneurysms and Mid-Left Ventricular Obstruction in Hypertrophic Cardiomyopathy.

Autor:	Sherrid MV; Hypertrophic Cardiomyopathy Program, Leon Charney Division of Cardiology, New York University Langone Health, New York, New York, USA; Echocardiography Laboratory, New York University Langone Health, New York, New York, USA. Electronic address: Mark.sherrid@nyulangone.org., Bernard S; Echocardiography Laboratory, New York University Langone Health, New York, New York, USA., Tripathi N; Hypertrophic Cardiomyopathy Program, Leon Charney Division of Cardiology, New York University Langone Health, New York, New York, USA., Patel Y; Division of Cardiology, Mount Sinai West and Mount Sinai Morningside, New York, New York, USA., Modi V; Division of Cardiology, Mount Sinai West and Mount Sinai Morningside, New York, New York, USA., Axel L; Department of Radiology, New York University Langone Health, New York, New York, USA., Talebi S; Division of Cardiology, Mount Sinai West and Mount Sinai Morningside, New York, New York, USA., Ghoshhajra BB; Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA., Sanborn DY; Echocardiography Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA., Saric M; Echocardiography Laboratory, New York University Langone Health, New York, New York, USA., Adlestein E; Hypertrophic Cardiomyopathy Program, Leon Charney Division of Cardiology, New York University Langone Health, New York, New York, USA., Alvarez IC; Hypertrophic Cardiomyopathy Program, Leon Charney Division of Cardiology, New York University Langone Health, New York, New York, USA., Xia Y; Division of Biostatistics, New York University Langone Health, New York, New York, USA., Swistel DG; Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York, USA., Massera D; Hypertrophic Cardiomyopathy Program, Leon Charney Division of Cardiology, New York University Langone Health, New York, New York, USA; Echocardiography Laboratory, New York University Langone Health, New York, New York, USA., Fifer MA; Hypertrophic Cardiomyopathy Program, Massachusetts General Hospital, Boston, Massachusetts, USA., Kim B; Echocardiography Laboratory and Cardiomyopathy Program, Mount Sinai West and Mount Sinai Morningside, New York, New York, USA.
Jazyk:	angličtina
Zdroj:	JACC. Cardiovascular imaging [JACC Cardiovasc Imaging] 2023 May; Vol. 16 (5), pp. 591-605. Date of Electronic Publication: 2023 Jan 11.
DOI:	10.1016/j.jcmg.2022.11.013
Abstrakt:	Background: Apical left ventricular (LV) aneurysms in hypertrophic cardiomyopathy (HCM) are associated with adverse outcomes. The reported frequency of mid-LV obstruction has varied from 36% to 90%. Objectives: The authors sought to ascertain the frequency of mid-LV obstruction in HCM apical aneurysms. Methods: The authors analyzed echocardiographic and cardiac magnetic resonance examinations of patients with aneurysms from 3 dedicated programs and compared them with 63 normal controls and 47 controls with apical-mid HCM who did not have aneurysms (22 with increased LV systolic velocities). Results: There were 108 patients with a mean age of 57.4 ± 13.5 years; 40 (37%) were women. A total of 103 aneurysm patients (95%) had mid-LV obstruction with mid-LV complete systolic emptying. Of the patients with obstruction, 84% had a midsystolic Doppler signal void, a marker of complete flow cessation, but only 19% had Doppler systolic gradients ≥30 mm Hg. Five patients (5%) had relative hypokinesia in mid-LV without obstruction. Aneurysm size is not bimodal but appears distributed by power law, with large aneurysms decidedly less common. Comparing mid-LV obstruction aneurysm patients with all control groups, the short-axis (SAX) systolic areas were smaller (P < 0.007), the percent SAX area change was greater (P < 0.005), the papillary muscle (PM) areas were larger (P < 0.003), and the diastolic PM areas/SAX diastolic areas were greater (P < 0.005). Patients with aneurysms had 22% greater SAX PM areas compared with those with elevated LV velocities but no aneurysms (median: 3.00 cm 2 [IQR: 2.38-3.70 cm 2 ] vs 2.45 [IQR: 1.81-2.95 cm 2 ]; P = 0.004). Complete emptying occurs circumferentially around central PMs that contribute to obstruction. Late gadolinium enhancement was always brightest and the most transmural apical of, or at the level of, complete emptying. Conclusions: The great majority (95%) of patients in the continuum of apical aneurysms have associated mid-LV obstruction. Further research to investigate obstruction as a contributing cause to apical aneurysms is warranted. Competing Interests: Funding Support and Author Disclosures Dr Sherrid has served as a consultant for Pfizer. Dr Massera has served as a consultant for Bristol Myers Squibb. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. (Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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