Cardiac magnetic resonance as a risk re-stratification tool in apical hypertrophic cardiomyopathy

Figures

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  Figure 1. Main findings at transthoracic echocardiography in the patient. Panels A and B demonstrate hypertrophy of both the ventricular septum and lateral wall at mid-ventricular and apical levels in parasternal long-axis and apical four-chamber views, respectively. Panels C and D depict a mid-ventricular paradoxical jet flow from the apical to the basal chamber in diastole (indicated by orange arrows) and dynamic obstruction caused by head-on septum to lateral wall motion and high intra-apical end-systolic pressure (indicated by the blue arrow).

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  Figure 2. Determination of left ventricular (LV) systolic function parameters. Panel A shows a three-dimensional echocardiography image with normal LV volumes and ejection fraction. Panel B displays an LV global longitudinal strain map with altered myocardial deformation in the hypertrophic LV segments

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  Figure 4. Comparative images from CMR 2013 (Panels A, B, and C) to 2020 (Panels D, E, and F) in the patient. Panels A and B display the 2013 CINE images at end-diastole and end-systole, respectively. In the end-systolic frame (Panel B), mid-ventricular dynamic obstruction caused by head-on septum to lateral wall motion is observed (indicated by black asterisks), and no apical aneurysm is present. Panel C shows a late-gadolinium enhancement image with the presence of fibrosis in the hypertrophic walls, estimated to be 13% of LV mass (indicated by a yellow arrow). Panels D and E depict the 2020 CINE images at end-diastole and end-systole. In the end-systolic frame (Panel E), mid-ventricular dynamic obstruction caused by head-on septum to lateral wall motion is observed (indicated by black asterisks), along with the formation of a small apical aneurysm (indicated by red arrows). Panel F demonstrates progressive fibrosis and an increase in the amount of fibrosis to 24.9% of LV mass (indicated by a yellow arrow).