Spectral doppler features in hypertrophic cardiomyopathy with left ventricular apical aneurysm

Background Left ventricular apical aneurysm (LVAA) occurs in up to 5% of patients with hypertrophic cardiomyopathy (HCM) and is an important marker of adverse prognosis[1]. Conventional echocardiography often misses LVAA, whereas more precise imaging modalities such as cardiac magnetic resonance and contrast echocardiography are limited by procedural complexity and high cost. This study aims to systematically investigate the Doppler spectral characteristics of HCM complicated by LVAA and to explore elastic recoil flow[2]. Objective To investigate the Doppler spectral characteristics of HCM with LVAA, assess their diagnostic and prognostic value, and explore the significance of elastic recoil flow. Methods Among 837 consecutive patients with HCM enrolled from January 2017 to August 2025, those with suspected LVAA were screened. A total of 135 patients were ultimately included, all of whom had undergone contrast echocardiography. Patients were divided into an LVAA group and a non-LVAA group, with further subgroup analyses. Thirty healthy volunteers served as controls. Clinical data, morphological features, and Doppler parameters were compared among groups. Results The LVAA group comprised 45 patients (33% of the study cohort; 5% of the overall HCM population). Early diastolic paradoxical flow was an independent predictor of LVAA presence (OR=696.000, P<0.001), with 95.6% sensitivity and 94.4% specificity. For small LVAA (≤20 mm), sensitivity and specificity were 91.7% and 94.4%, respectively(Fig.2). When the LVAA group was subdivided by aneurysm size (small ≤20 mm vs. large >20 mm), the void period (OR=0.986) and paradoxical wave VTI (OR=1.083) were independent predictors of small LVAA (both P<0.05). The void period correlated inversely with LVAA size (r=-0.394, AUC 0.739), while paradoxical wave VTI correlated positively (r=0.314, AUC 0.708); their combination improved predictive performance (AUC 0.812). When stratified by area change rate (≤0% vs. >0%), paradoxical wave VTI/(systolic VTI+paradoxical wave VTI) independently predicted an area change rate ≤0% (OR=8584.996, P<0.05), with an inverse correlation (r=-0.405, AUC 0.723). The non-LVAA group was subdivided into pure HCM and LVAA-mimicking groups. Elastic recoil flow spectral parameters showed no significant differences among the control, pure HCM, LVAA-mimicking, and LVAA groups (P>0.05). Conclusion Early diastolic paradoxical flow accurately indicates the presence of LVAA, with particularly high diagnostic efficacy for small aneurysms. Certain Doppler parameters may predict LVAA size and function to some extent. However, elastic recoil flow does not serve as a marker for either LVAA-mimicking conditions or LVAA itself. These findings suggest that spectral Doppler examination of the left ventricular apex or mid-ventricle should be routinely performed in HCM patients with suspected LVAA.