Presentation
Hypertrophic cardiomyopathy with thickened left ventricular septum on echocardiography.
Patient Data
Heart rate: 62 bpm
Image quality: mild to moderate respiratory artifacts, otherwise no limitations
Morphology and functional analysis (endo-volume - including papillary muscles):
LV-EDVI: 93 mL/m²
LV-ESVI: 35 mL/m²
LV-SVI: 58 mL/m²
LV-EF: 63%
cardiac output: 6.4 L/min
cardiac index: 3.7 L/min/m²
LV-ED wall mas index (without papillary muscles): 70 g/cm
septum thickness: 20 mm
inferior wall thickness: 7 mm
Findings:
asymmetric mass-like thickening of the basal septum
visually normal atrial size
systolic anterior motion of the mitral valve
diastolic jet in the left ventricular outflow tract
no intracavitary thrombi, no ventricular aneurysm
no pericardial effusion
Myocardial tissue properties
fan-shaped, patchy late gadolinium enhancement at the right ventricular insertion points
T1 mapping native: mildly elevated, movement artifacts in the lateral segments
extracellular volume (ECV): elevated (>32%) in the basal anteroseptal and inferoseptal segments
T2 mapping: mildly elevated (~57 ms) in the midventricular inferoseptal segment with normal values in the remote myocardium ( 52 ms)
*Normal reference ranges based on local data:
native T1: 940-1060 ms; ECV: <32%; T2: 44-56 ms
QFlow (aortic annulus):
regurgitant fraction: ~12%
peak velocity: ~142 cm/s
peak pressure gradient <10 mmHg
Impression:
asymmetric hypertrophic cardiomyopathy almost mass-like phenotype
preserved systolic function
mild aortic valve insufficiency
Exam courtesy: Tobias Jahn & Sven Winzler (radiographers)
Case Discussion
A case of asymmetric hypertrophic cardiomyopathy with mild subaortic stenosis and partial systolic anterior motion of the mitral valve. Since the pressure gradient obtained by phase contrast imaging was rather low, echocardiographic reevaluation and/or follow-up was recommended. The case also demonstrates a typical pattern of myocardial fibrosis in the basal and midventricular septal segments at the anterior and posterior right ventricular insertion points.