Multimodality imaging in hypertrophic cardiomyopathy

Fig. 1. Transthoracic echocardiography of 38-year-old male patient with hypertrophic cardiomyopathy. No definite myocardial hypertrophy is observed in the (A) apical four-chamber and B two-chamber views. C However, thickening of the basal anterior wall is noted in the parasternal short-axis view. D A slightly adjusted apical two-chamber view demonstrates basal anterior wall hypertrophy (asterisk). E Longitudinal strain is reduced in the basal anteroseptal and anterior walls

Fig. 2. Contrast echocardiography. A Transthoracic echocardiography revealing thickening of the mid-inferoseptal wall, while the apical myocardium not being clearly visualized. B Following contrast injection, the apical myocardium becomes well visualized

Fig. 3. Cardiac magnetic resonance images showing atypical presentations of hypertrophic cardiomyopathy. Hypertrophied myocardium of the mid-anterolateral wall is observed in both (A) the apical four-chamber view and B the parasternal short-axis view

Fig. 4. Patients with apical aneurysm. Compared to the suboptimal image quality of (A) transthoracic echocardiography, B cardiac magnetic resonance imaging clearly reveals a small apical aneurysm during the systolic phase

Fig. 5. In this patient with hypertrophic cardiomyopathy, left ventricular ejection fraction was 61.4%; however, longitudinal strain was reduced to –10.3%

Fig. 6. Transthoracic echocardiography of patients with obstructive hypertrophic cardiomyopathy. Apical three-chamber view at (A) end-diastole and B during systole demonstrate systolic anterior motion of the mitral valve (asterisk)

Fig. 7. Continuous-wave Doppler demonstrates (A) the characteristic “dagger-shaped” profile in a patient with hypertrophic cardiomyopathy and dynamic left outflow tract obstruction, compared to (B) the relatively rounded profile seen in aortic stenosis

Fig. 8. A patient with obstructive hypertrophic cardiomyopathy demonstrates (A) both mitral regurgitation as well as dynamic left ventricular outflow tract obstruction. B The continuous-wave Doppler signal is partially contaminated by the mitral regurgitation jet (asterisk)

Fig. 9. The Brockenbrough-Braunwald-Morrow sign. Simultaneous pressure tracings of the left ventricle (pink line) and aorta (green line) demonstrate a resting peak pressure gradient of approximately 50 mmHg between the left ventricle and aorta. Following a premature ventricular contraction, the pressure gradient increased markedly to 190 mmHg, accompanied by a drop in aortic pressure

Fig. 10. Continuous-wave Doppler demonstrates a relatively early-peaking velocity profile

Fig. 11. Late gadolinium enhancement in (A) the four-chamber view and B the short-axis view in a patient with hypertrophic cardiomyopathy