Multimodality Cardiac Imaging in Cardiomyopathies: From Diagnosis to Prognosis

Figures

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  Figure 1. A parasternal long-axis view of a patient with septal HCM. Note the marked increase in septal wall thickness and the asymmetry compared to the posterior wall.

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  Figure 2. Different hypertrophic cardiomyopathy phenotypes. (A) Septal HCM. (B) Apical HCM. (C) Diffuse HCM.

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  Figure 3. Ancillary signs in HCM. (A) Myocardial crypts in the inferior wall. (B) Apical aneurysm in a patient with apical HCM. (C) Apical insertion of the papillary muscles in a patient with septal HCM. (D) Outflow tract obstruction measured on Doppler CW, note the dagger-shaped curve. (E) SAM evidenced on M-mode: see the movement of the anterior mitral leaflet towards the septum in systole.

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  Figure 4. CMR study of a patient with septal HCM. (A) Maximal wall thickness measured on the short-axis cine stack at end-diastole. (B) Post-contrast T1 sequences showing extensive basal and mid-anteroseptal LGE with an intramyocardial pattern.

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  Figure 5. CMR study of a patient with septal HCM. (A,B) LGE sequences with heterogeneous contrast uptake in the basal and mid-anteroseptal segments. (C) Native T1 mapping sequence with an increased native T1 value of 1108 ms in the basal anteroseptal segment (reference range 950–1050 ms).

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  Figure 6. Stress echocardiography in a patient with HCM. Note the marked increase in SAM (B, white arrow) and the significant increase in LVOTO (D) at peak stress compared to the basal situation (A,C).

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  Figure 7. Transthoracic echocardiography of a patient with dilated cardiomyopathy, showing a parasternal long-axis view (A) and an apical 4-chambers view (B). Note the marked dilatation of the left ventricle and the spherical pattern.

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  Figure 8. Three-dimensional transthoracic echocardiography of the left ventricle. (A) Triplane view of the LV allows simultaneous and single-beat acquisition of the three apical views. By tracing the endocardial borders, the LV volume is obtained (surface rendering, bottom right). (B) Real-time single-beat 3D acquisition of the LV from the apical window. Volume renders allow for offline reconstructions. (C) Tomographic multislice obtained from a multiple-beat apical view. Wall motion abnormalities can be assessed with this technique.

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  Figure 9. Longitudinal strain analysis of a patient with DCM: 4 chambers (A), 2 chambers (B), 3 chambers (C), and bull’s eye plot (D). Note the diffusely affected longitudinal strain, consistent with depressed LVEF, and positive values in the basal septum suggestive of dyskinesia in these segments.

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  Figure 10. Myocardial work analysis in a patient with DCM. (A) Strain—pressure loop. (B) Comparison of constructive work (green) and wasted work (blue). (C) Bull’s eye plot of myocardial work index (mmHg%). (D) Bull’s eye plot of myocardial work efficiency (%).

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  Figure 11. CMR study of a patient with DCM. (A) Short-axis cine stack. (B,C) Post-contrast T1 sequences showing a typical LGE pattern with a lineal mid-septum uptake as well as a focal uptake in the septum-free wall inferior junction.

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  Figure 12. Strain analysis by CMR obtained with feature-tracking software in a patient with DCM. Endocardial and epicardial segmentation of short and long-axis is required, both at end-diastole and end-systole. Thus, longitudinal (A), radial (B), and circumferential (C) strain are simultaneously acquired.