ArticleCJC open2026
Early Diastolic Release Flow Is a Sensitive Early Marker for Left Ventricular Apical Aneurysm in Patients with Hypertrophic Cardiomyopathy.
Article in CJC open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Left ventricular apical aneurysm (LVAA) is a rare but important finding in hypertrophic cardiomyopathy (HCM) that is associated with increased risk for ventricular arrhythmia and thromboembolism. Doppler evidence of basally-directed flow during early diastole representing the release of pressurized blood volume during ventricular relaxation may serve as a more sensitive marker for LVAA than standard 2D echocardiography. Methods: HCM patients with LVAA and available echocardiography were enrolled. Clinical echocardiographic studies were assessed for evidence of early-diastolic release flow (EDRF), defined as basally-directed flow identified in early diastole. Sensitivity of EDRF for detection of LVAA was compared to alternative imaging modalities. In patients with repeat echocardiography at 5-years, changes in aneurysm size and EDRF flow characteristics were assessed. Results: 51 HCM patients with LVAA were enrolled. While standard 2d echocardiography had low sensitivity for LVAA (25/51, 49%), EDRF was detected in 46/51 patients (90%). In the subset of patients for whom LVAA was missed on 2D echocardiography, sensitivity of EDRF remained high (26/26, 100%). In patients with 5-year longitudinal imaging (n=16, 31%), mean aneurysm size increased (17mm vs 25mm, p-value=0.0002) and LVEF decreased (62% vs 54%, p-value=0.002); EDRF visualization was lost in 4 (25%). Specificity of EDRF for LVAA diagnosis was 96.4% in control patients with apical variant HCM. Conclusions: EDRF is a sensitive early echocardiographic marker of LVAA that is most useful for LVAA that would otherwise be missed on standard 2D echocardiography. Identification should prompt definitive testing with CMR or contrast-enhanced echocardiography.
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