Key result
Invasive hemodynamics detect a 73 mmHg provoked gradient, showing echocardiography underestimated mid-cavity obstruction in HCM.
Why the study?
Mid-cavity obstruction in hypertrophic cardiomyopathy can be underdiagnosed when relying solely on noninvasive imaging.
Does invasive hemodynamic assessment improve the detection and quantification of dynamic mid-cavity obstruction in hypertrophic cardiomyopathy compared to noninvasive imaging?
Does invasive hemodynamic assessment improve the detection and quantification of dynamic mid-cavity obstruction in hypertrophic cardiomyopathy compared to noninvasive imaging?
Invasive hemodynamic assessment is crucial for accurately diagnosing dynamic mid-cavity obstruction in hypertrophic cardiomyopathy, as it can be significantly underestimated by echocardiography.
Consider invasive hemodynamics in suspected mid-cavity HCM; hypothesis-generating and extends evidence beyond echocardiography.
Background Hypertrophic cardiomyopathy (HCM) is a genetic disorder causing myocardial hypertrophy, sometimes leading to mid‐cavity obstruction (MCO), which can be underdiagnosed based solely on noninvasive imaging. Case summary A 52‐year‐old male with exertional dyspnea and chest pain showed apical hypertrophy on echocardiography, with a mid‐cavity gradient of 27 mmHg at rest and 39 mmHg during Valsalva. MRI confirmed nonischemic late gadolinium enhancement. Invasive dual‐catheterization detected a midventricular gradient of 57 mmHg, rising to 73 mmHg postprovocation. Coronary artery disease was excluded. The patient was managed with beta‐blockers, mavacamten, and aerobic training. Discussion This case highlights the importance of invasive hemodynamic assessment in diagnosing dynamic MCO, which may be underestimated on echocardiography. Provocation testing and simultaneous pressure measurements aid in accurate diagnosis and individualized therapy. Take‐Home Messages Invasive assessment is crucial for detecting dynamic MCO in HCM. Myosin inhibitors may offer a novel therapeutic option.
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Maaroufi et al. (2026) studied this question. Invasive hemodynamic assessment revealed a 73 mmHg provoked gradient, showing echocardiography (39 mmHg) underestimated mid-cavity obstruction in a hypertrophic cardiomyopathy patient.
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