Background
Apical aneurysm is a subtype of hypertrophic cardiomyopathy that carries significant morbidity and mortality consequences. Diagnosis of apical aneurysm by echo is limited due to near field artifacts. MRI (and CT) are considered gold standard. We suggest that apical diastolic flow reversal as measured by colored or pulse Doppler may increase the sensitivity for apical aneurysm diagnosis by echocardiography.
Methods
We reviewed the institutional database for patients who were diagnosed on echocardiography or MRI with apical hypertrophy, mid ventricular obstruction or apical aneurysm. The echocardiograms were reviewed to detect apical diastolic flow reversal by color Doppler, frame by frame observation or reverse dagger shape by pulse wave Doppler. We excluded systolic anterior motion of the mitral valve as a mechanism for the reversed flow. MRI or CT, when available, served as gold standard for the diagnosis of apical aneurysm.
Results
Sixteen patients with apical hypertrophy, mid ventricular obstruction or apical aneurysm were included. Six patients had apical aneurysm on echocardiography, MRI or CT, and all 6 had apical diastolic flow reversal (100% sensitivity). Ten patients did not have apical aneurysm on echocardiogram, only 3 of them had MRI to confirm the diagnosis. Nine of these patients did not have apical diastolic flow reversal, which was found only in one patient who did not have a confirmatory MRI.
Conclusions
Diastolic flow reversal by echocardiography may increase the sensitivity of echo to detect apical aneurysm. In our small cohort the sensitivity of apical diastolic flow reversal for apical aneurysm was a 100%. Further larger cohorts are needed to evaluate specificity.
