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Tabira A, Misumi I, Sato K, Matsuda H, Iwasaki T, Usuku H, Tsujita K. Mid-ventricular Obstructive Cardiomyopathy after Takotsubo Cardiomyopathy. Intern Med 2023; 62:2365-2373. [PMID: 36543216 PMCID: PMC10484758 DOI: 10.2169/internalmedicine.1090-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/15/2022] [Indexed: 12/24/2022] Open
Abstract
A 93-year-old woman was transferred to our hospital for lightheadedness. She had had Takotsubo cardiomyopathy for seven years. Transthoracic apical four-chamber echocardiography showed a large apical aneurysm. Pulsed-wave Doppler echocardiography at the left ventricular (LV) basal obstruction showed flow directed from the apex to the base during systole and isovolumic relaxation time. The patient was therefore diagnosed with mid-ventricular obstructive cardiomyopathy with a large apical aneurysm and paradoxical flow. The present case suggests that Takotsubo cardiomyopathy may become mid-ventricular obstructive hypertrophic cardiomyopathy without change in its structure.
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Affiliation(s)
| | - Ikuo Misumi
- Department of Cardiology, Kumamoto City Hospital, Japan
| | - Koji Sato
- Department of Cardiology, Kumamoto City Hospital, Japan
| | | | | | - Hiroki Usuku
- Department of Cardiovascular Medicine, Kumamoto University School of Medicine, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Kumamoto University School of Medicine, Japan
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Sherrid MV, Bernard S, Tripathi N, Patel Y, Modi V, Axel L, Talebi S, Ghoshhajra BB, Sanborn DY, Saric M, Adlestein E, Alvarez IC, Xia Y, Swistel DG, Massera D, Fifer MA, Kim B. Apical Aneurysms and Mid-Left Ventricular Obstruction in Hypertrophic Cardiomyopathy. JACC Cardiovasc Imaging 2023; 16:591-605. [PMID: 36681586 DOI: 10.1016/j.jcmg.2022.11.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 11/10/2022] [Accepted: 11/14/2022] [Indexed: 01/13/2023]
Abstract
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. One hundred three 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 cm2 [IQR: 2.38-3.70 cm2] vs 2.45 [IQR: 1.81-2.95 cm2]; 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.
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Affiliation(s)
- Mark V Sherrid
- 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.
| | - Samuel Bernard
- Echocardiography Laboratory, New York University Langone Health, New York, New York, USA
| | - Nidhi Tripathi
- Hypertrophic Cardiomyopathy Program, Leon Charney Division of Cardiology, New York University Langone Health, New York, New York, USA
| | - Yash Patel
- Division of Cardiology, Mount Sinai West and Mount Sinai Morningside, New York, New York, USA
| | - Vivek Modi
- Division of Cardiology, Mount Sinai West and Mount Sinai Morningside, New York, New York, USA
| | - Leon Axel
- Department of Radiology, New York University Langone Health, New York, New York, USA
| | - Soheila Talebi
- Division of Cardiology, Mount Sinai West and Mount Sinai Morningside, New York, New York, USA
| | - Brian B Ghoshhajra
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Danita Y Sanborn
- Echocardiography Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Muhamed Saric
- Echocardiography Laboratory, New York University Langone Health, New York, New York, USA
| | - Elizabeth Adlestein
- Hypertrophic Cardiomyopathy Program, Leon Charney Division of Cardiology, New York University Langone Health, New York, New York, USA
| | - Isabel Castro Alvarez
- Hypertrophic Cardiomyopathy Program, Leon Charney Division of Cardiology, New York University Langone Health, New York, New York, USA
| | - Yuhe Xia
- Division of Biostatistics, New York University Langone Health, New York, New York, USA
| | - Daniel G Swistel
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York, USA
| | - Daniele Massera
- 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
| | - Michael A Fifer
- Hypertrophic Cardiomyopathy Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Bette Kim
- Echocardiography Laboratory and Cardiomyopathy Program, Mount Sinai West and Mount Sinai Morningside, New York, New York, USA
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Misumi I, Sato K, Hanatani S, Nagayoshi Y, Sakaino N, Urata J, Tsujita K. Pseudo-Paradoxical Jet Flow in a Patient with Midventricular Obstructive Hypertrophic Cardiomyopathy. CASE 2020; 4:179-188. [PMID: 32577602 PMCID: PMC7303248 DOI: 10.1016/j.case.2020.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Additional apical obstruction may lower LV obstruction flow velocity. LV systole may last to the end of IVRT. PSS may cause intraventricular flow. Isovolumic relaxation flow does not always imply the presence of apical aneurysm.
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Tezuka A, Higo K, Nakamukae Y, Nishihara S, Kamikawa M, Shimofuku C, Kawazoe K, Ohishi M. Bisoprolol Successfully Improved the Intraventricular Pressure Gradient in a Patient with Midventricular Obstructive Hypertrophic Cardiomyopathy with an Apex Aneurysm due to Apical Myocardial Damage. Intern Med 2019; 58:535-539. [PMID: 30333393 PMCID: PMC6421145 DOI: 10.2169/internalmedicine.0997-18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 05/20/2018] [Indexed: 01/19/2023] Open
Abstract
Midventricular obstructive hypertrophic cardiomyopathy (MVOHCM) is a rare form of hypertrophic cardiomyopathy (HCM). An 80-year-old man was administered bisoprolol and warfarin therapies as treatment for MVOHCM with an apex aneurysm due to myocardial damage and intra-aneurysmal thrombus not complicated by atrial fibrillation. The pressure gradient in the midventricle successfully improved from 53.9 to 21.8 mmHg, and the intra-aneurysmal thrombus disappeared.
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Affiliation(s)
- Ayano Tezuka
- Departments of Cardiovascular Medicine, Japanese Red Cross Kagoshima Hospital, Japan
| | - Kenjuro Higo
- Departments of Cardiovascular Medicine, Japanese Red Cross Kagoshima Hospital, Japan
| | - Yuta Nakamukae
- Departments of Clinical Laboratory Unit, Japanese Red Cross Kagoshima Hospital, Japan
| | - Sanae Nishihara
- Departments of Clinical Laboratory Unit, Japanese Red Cross Kagoshima Hospital, Japan
| | - Masaki Kamikawa
- Departments of Clinical Laboratory Unit, Japanese Red Cross Kagoshima Hospital, Japan
| | - Chihiro Shimofuku
- Departments of Clinical Laboratory Unit, Japanese Red Cross Kagoshima Hospital, Japan
| | - Kazumasa Kawazoe
- Departments of Neurosurgery, Japanese Red Cross Kagoshima Hospital, Japan
| | - Mitsuru Ohishi
- Departments of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan
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Elsheshtawy MO, Mahmoud AN, Abdelghany M, Suen IH, Sadiq A, Shani J. Left ventricular aneurysms in hypertrophic cardiomyopathy with midventricular obstruction: A systematic review of literature. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:854-865. [PMID: 29786883 DOI: 10.1111/pace.13380] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/11/2018] [Accepted: 05/05/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) with or without left ventricular apical aneurysm (LVA) had been studied in the past. Midventricular obstruction associated with HCM and LVA is a unique entity that has not been distinguished previously as a separate phenotypic disease in HCM patients. METHODS A systematic review of Pubmed and Google Scholar was conducted from inception until September 2017 for all observational studies conducted on HCM with midventricular obstruction and LVA. RESULTS A total of 94 patients from 39 studies were included in our analysis. The mean age of the patients was 58.05 ± 11.76 years with 59.6% being males. The most common electrocardiographic finding was T wave inversion occurring in 13.8% of the cases followed by ST elevation (9.5%). Maximal left ventricle (LV) wall thickness was reported 18.89 ± 5.19 mm on transthoracic echocardiography and paradoxical jet flow was detected in 29.8% of patients. Beta-blockers (58.5%) were the most common drug therapy at baseline and amiodarone (10.6%) was the most common antiarrhythmic used for ventricular tachycardia (VT). The most common complication, VT, occurred in 39.3% of cases and the incidence of all-cause mortality was 13.8 % over 16 ± 20.1 months follow-up. Implantable cardioverter defibrillator (ICD) was used in 37.2% of patients; 25.7% of patients with ICD received appropriate shock therapy. CONCLUSION HCM with LVA and midventricular obstruction is a unique entity that appears to be associated with high incidence of morbidity and mortality. Thus, early diagnosis and therapeutic intervention is recommended for management of this condition.
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Affiliation(s)
- Moustafa O Elsheshtawy
- Division of Cardiovascular Medicine, Department of Medicine, Maimonides Medical Center, Brooklyn, NY, USA.,Division of Cardiovascular Medicine, Department of Medicine, Coney Island Hospital, Brooklyn, NY, USA
| | - Ahmed N Mahmoud
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Mahmoud Abdelghany
- Division of Cardiovascular Medicine, Department of Medicine, State University of New York, Upstate Medical University, Syracuse, NY, USA
| | - Ida H Suen
- Division of Cardiovascular Medicine, Department of Medicine, Coney Island Hospital, Brooklyn, NY, USA
| | - Adnan Sadiq
- Division of Cardiovascular Medicine, Department of Medicine, Maimonides Medical Center, Brooklyn, NY, USA
| | - Jacob Shani
- Division of Cardiovascular Medicine, Department of Medicine, Maimonides Medical Center, Brooklyn, NY, USA
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Po JRF, Kim B, Aslam F, Arabadjian M, Winson G, Cantales D, Kushner J, Kornberg R, Sherrid MV. Doppler Systolic Signal Void in Hypertrophic Cardiomyopathy: Apical Aneurysm and Severe Obstruction without Elevated Intraventricular Velocities. J Am Soc Echocardiogr 2015; 28:1462-73. [DOI: 10.1016/j.echo.2015.08.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Indexed: 12/28/2022]
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Cui L, Suo Y, Zhao Y, Li G, Liu T. Mid-Ventricular Obstructive Hypertrophic Cardiomyopathy and Apical Aneurysm Mimicking Acute ST-Elevation Myocardial Infarction. Ann Noninvasive Electrocardiol 2015; 21:98-101. [PMID: 26105174 DOI: 10.1111/anec.12284] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Nonischemic ST-segment elevation may be confused as acute ST-elevation myocardial infarction (STEMI), especially in patients with atypical presenting symptoms. Among the possible differential diagnosis, hypertrophic cardiomyopathy (HCM) should be considered. Mid-ventricular obstructive hypertrophic cardiomyopathy (MVOHCM) is a rare type of cardiomyopathy, accounting for approximately 5% of all HCM cases. ST-segment elevation on electrocardiogram (ECG) in patients with MVOHCM is a rare clinical presentation. We present a case of MVOHCM and apical aneurysm mimicking acute STEMI.
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Affiliation(s)
- Li Cui
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Ya Suo
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Yuntao Zhao
- Department of Cardiology, Aerospace Center Hospital, Beijing, China
| | - Guangping Li
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
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Misumi I, Honda T, Kurokawa H, Kubota Y, Ishii M, Sato R, Yamabe H, Yasuda H, Kaikita K, Hokimoto S, Ogawa H. Systolic Flow Reversal in a Case of Mid-Ventricular Obstructive Hypertrophic Cardiomyopathy. Intern Med 2015; 54:1765-9. [PMID: 26179533 DOI: 10.2169/internalmedicine.54.4153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 69-year-old man presented to our hospital with chest pain. Two-dimensional transthoracic echocardiography showed hypertrophy of the left ventricle, mid-ventricular obstruction and an apical aneurysm. Color-flow imaging at the obstruction site on the apical four-chamber view demonstrated systolic flow reversal in addition to a paradoxical jet flow. The systolic flow reversal may have been caused by a decreased apical contractility and pressure during systole.
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Affiliation(s)
- Ikuo Misumi
- Department of Cardiology, Kumamoto Saisyunsou Hospital, Japan
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Thind M, Joson M, Gaba S, Elsayed M, Bulur S, Guvenc T, Elguindy M, Nanda NC. Incremental Value of Live/Real Time Three-Dimensional Transthoracic Echocardiography over Two-Dimensional Echocardiography in Hypertrophic Cardiomyopathy with Mid-Ventricular Obstruction and Apical Aneurysm. Echocardiography 2014; 32:565-9. [DOI: 10.1111/echo.12848] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
- Munveer Thind
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham Alabama
| | - Marisa Joson
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham Alabama
| | - Saurabh Gaba
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham Alabama
| | - Mahmoud Elsayed
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham Alabama
| | - Serkan Bulur
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham Alabama
| | - Tolga Guvenc
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham Alabama
| | - Mostafa Elguindy
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham Alabama
| | - Navin C. Nanda
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham Alabama
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Mid-systolic flow reversal in a patient with mid-ventricular obstructive hypertrophic cardiomyopathy. J Echocardiogr 2014; 12:78-80. [PMID: 27279055 DOI: 10.1007/s12574-014-0204-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 12/12/2013] [Accepted: 01/05/2014] [Indexed: 10/25/2022]
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