TT Hypertrophic Apical
May 29th, 2022
Pages 1 – 4
Apical hypertrophic cardiomyopathy diagnosed in the EP department
Post-arrhythmic atrial systolic stunning
![Figure 1. ECG at admission](https://echobyweb.com/wp-content/uploads/2022/05/T364_ECG_preablation-300x272.jpg)
A 57-year-old female (HR= 65 bpm; BP= 130/ 60 mmHg; BSA= 1.73 m2) was admitted in the EP department because of recurrent symptomatic paroxysmal atrial fibrillation. The baseline ECG (Figure 1) showed SR and deep negative T waves in the chest limbs.
The routine echocardiographic examination before the scheduled ablation procedure showed a severely dilated left atrium (86 ml/m2) (Figure 2), nodular calcifications of the posterior mitral annulus, and a reduced LV end-diastolic volume (28 ml/m2) with normal biplane ejection fraction (67 %). There was a mild tricuspid regurgitation and the estimated pulmonary systolic pressure was moderately increased (48 mmHg).
![Figure 3. Continous wave Doppler, parasternal short axis, pulmonary regurgitation](https://echobyweb.com/wp-content/uploads/2022/05/T364_ttcwpssapr-278x300.jpg)
![Figure 4. Pulsed Doppler, apical 4-chambers, mitral valve flow](https://echobyweb.com/wp-content/uploads/2022/05/T364_ttpdap4cmvf-286x300.jpg)
Pulmonary diastolic pressure (and thus LV filling pressure) was estimated as normal, by sampling the pulmonary regurgitation end-diastolic velocity (Figure 3):
Pulmonary diastolic pressure= 5.6 mmHg (end-diastolic gradient) + 6 mmHg (normal inspiratory collapsibility of the inferior vena cava) = 11.6 mmHg.
The combined analysis of the mitral valve flow profile (Figure 4) and the tissue Doppler sampling of the mitral annulus (in the 4-chambers view) (Figures 5-6) suggested left atrial systolic stunning (post-arrhythmic: recent spontaneous cardioversion of paroxysmal atrial fibrillation): the E/A ratio is high (2.1) in a 57-year-old patient with normal LV systolic function and filling pressure, and the peak A wave velocity (atrial systolic function) is reduced both at mitral flow velocity sampling and tissue Doppler mitral annulus sampling.
![Figure 5. Tissue Doppler, apical 4-chambers, medial mitral annulus](https://echobyweb.com/wp-content/uploads/2022/05/T364_tttdilvmed-287x300.jpg)
![Figure 6. Tissue Doppler, apical 4-chambers, lateral mitral annulus](https://echobyweb.com/wp-content/uploads/2022/05/T364_tttdilvlat-296x300.jpg)