{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T02:22:53Z","timestamp":1772158973432,"version":"3.50.1"},"reference-count":52,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2018,12,12]],"date-time":"2018-12-12T00:00:00Z","timestamp":1544572800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Echocardiography"],"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Acute left ventricular (<jats:styled-content style=\"fixed-case\">LV<\/jats:styled-content>) apical ballooning with normal coronary angiography occurs rarely in obstructive hypertrophic cardiomyopathy (<jats:styled-content style=\"fixed-case\">OHCM<\/jats:styled-content>); it may be associated with severe hemodynamic instability.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods, Results<\/jats:title><jats:p>We searched for acute <jats:styled-content style=\"fixed-case\">LV<\/jats:styled-content> ballooning with apical hypokinesia\/akinesia in databases of two <jats:styled-content style=\"fixed-case\">HCM<\/jats:styled-content> treatment programs. Diagnosis of <jats:styled-content style=\"fixed-case\">OHCM<\/jats:styled-content> was made by conventional criteria of <jats:styled-content style=\"fixed-case\">LV<\/jats:styled-content> hypertrophy in the absence of a clinical cause for hypertrophy and mitral\u2010septal contact. Among 1519 patients, we observed acute <jats:styled-content style=\"fixed-case\">LV<\/jats:styled-content> ballooning in 13 (0.9%), associated with dynamic left ventricular outflow tract (<jats:styled-content style=\"fixed-case\">LVOT<\/jats:styled-content>) obstruction and high gradients, 92\u00a0\u00b1\u00a037\u00a0mm\u00a0Hg, 10 female (77%), age 64\u00a0\u00b1\u00a07\u00a0years, <jats:styled-content style=\"fixed-case\">LVEF<\/jats:styled-content> 31.6\u00a0\u00b1\u00a010%. Septal hypertrophy was mild compared to that of the rest of our <jats:styled-content style=\"fixed-case\">HCM<\/jats:styled-content> cohort, 15 vs 20\u00a0mm (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.00001). An elongated anterior mitral leaflet or anteriorly displaced papillary muscles occurred in 77%. Course was complicated by cardiogenic shock and heart failure in 5, and refractory heart failure in 1. High\u2010dose beta\u2010blockade was the mainstay of therapy. Three patients required urgent surgical relief of <jats:styled-content style=\"fixed-case\">LVOT<\/jats:styled-content> obstruction, 2 for refractory cardiogenic shock, and one for refractory heart failure. In the three patients, surgery immediately normalized refractory severe <jats:styled-content style=\"fixed-case\">LV<\/jats:styled-content> dysfunction, and immediately reversed cardiogenic shock and heart failure. All have normal <jats:styled-content style=\"fixed-case\">LV<\/jats:styled-content> systolic function at 45\u2010month follow\u2010up, and all have survived.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Acute <jats:styled-content style=\"fixed-case\">LV<\/jats:styled-content> apical ballooning, associated with high dynamic <jats:styled-content style=\"fixed-case\">LVOT<\/jats:styled-content> gradients, may punctuate the course of obstructive <jats:styled-content style=\"fixed-case\">HCM<\/jats:styled-content>. The syndrome is important to recognize on echocardiography because it may be associated with profound reversible <jats:styled-content style=\"fixed-case\">LV<\/jats:styled-content> decompensation.<\/jats:p><\/jats:sec>","DOI":"10.1111\/echo.14212","type":"journal-article","created":{"date-parts":[[2018,12,13]],"date-time":"2018-12-13T06:38:06Z","timestamp":1544683086000},"page":"47-60","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Hypertrophic cardiomyopathy with dynamic obstruction and high left ventricular outflow gradients associated with paradoxical apical ballooning"],"prefix":"10.1111","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4972-7780","authenticated-orcid":false,"given":"Mark V.","family":"Sherrid","sequence":"first","affiliation":[{"name":"Hypertrophic Cardiomyopathy Program Division of Cardiology New York University Langone Health New York University School of Medicine  New York 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