[Follow-up study of diastolic paradoxical flow in the left ventricle with apical hypertrophic cardiomyopathy].

OBJECTIVES

Left ventricular apical asynergy and cardiovascular complications were evaluated in patients with apical hypertrophic cardiomyopathy, in whom apical diastolic paradoxical flow toward the base could be detected by Doppler color flow echocardiography.

METHODS

Twenty-nine patients with apical hypertrophic cardiomyopathy were followed up with echocardiographic examinations for at least 5 years. They were divided into three groups: those who persistently exhibited paradoxical flow (Group A, n = 13), those in whom paradoxical flow developed during the follow-up period (Group B, n = 8), and those in whom paradoxical flow was not detected during the follow-up period (Group C, n = 8). Peak flow velocity and duration of paradoxical flow, the presence or absence of apical asynergy, and cardiovascular complications were evaluated.

RESULTS

The mean follow-up period was 7.3 +/- 1.4 years. In Groups A and B, the apical wall motion deteriorated over time, whereas there was no asynergy change in Group C. Further, peak flow velocity and duration of paradoxical flow increased throughout the follow-up period in Groups A and B, and were correlated with the severity of apical asynergy. Ventricular tachycardia and cerebrovascular complications also occurred more often in patients with paradoxical flow.

CONCLUSIONS

The presence of paradoxical flow was related to the severity of apical asynergy and cardiovascular complications, and may be an important marker for evaluating the clinical course of patients with apical hypertrophic cardiomyopathy.