Doppler Systolic Signal Void in Hypertrophic Cardiomyopathy: Apical Aneurysm and Severe Obstruction without Elevated Intraventricular Velocities

Jose Ricardo F. Po, Bette Kim, Farhan Aslam, Milla Arabadjian, Glenda Winson, Deborah Cantales, Josef Kushner, Robert Kornberg, Mark V. Sherrid

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


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 cm2. 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 cm2 (r = 0.704; P =.001). Complete emptying <1 cm2 for ≥38% of systole was associated with akinetic aneurysm (odds ratio, 9.35; P <.004). Conclusion 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.

Original languageEnglish
Pages (from-to)1462-1473
Number of pages12
JournalJournal of the American Society of Echocardiography
Issue number12
StatePublished - 1 Dec 2015
Externally publishedYes


  • Apical aneurysm
  • Doppler echocardiography
  • Echocardiography
  • Hypertrophic cardiomyopathy
  • Obstructive hypertrophic cardiomyopathy


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