Exploring Morphologic and Functional Variants in Hypertrophic Cardiomyopathy: An Echocardiographic and Doppler Review

TL;DR

This review discusses how to use echocardiography to identify and understand different heart structure and function patterns in hypertrophic cardiomyopathy.

Contribution

The paper provides a focused review on echocardiographic techniques for diagnosing and evaluating HCM morphologic and functional variants.

Findings

Echocardiography is essential for diagnosing and monitoring HCM due to its morphologic and functional heterogeneity.

Apical HCM and left ventricular aneurysm present unique imaging challenges requiring specialized techniques.

Anatomical variants of the mitral valve and papillary muscles contribute to systolic anterior motion and mid-ventricular obstruction in HCM.

Abstract

Hypertrophic cardiomyopathy (HCM) is a complex and heterogeneous myocardial disorder, best evaluated with echocardiography for initial diagnosis, risk stratification, and longitudinal monitoring. This focused review explores the echocardiographic assessment of various morphologic phenotypes of HCM, emphasizing their diagnostic nuances. Distinct phenotypes, including asymmetric septal hypertrophy, concentric hypertrophy, and the less common apical HCM, present unique imaging challenges. Additionally, the review outlines essential techniques and practical tips for assessing left ventricular apical aneurysm flow patterns and dynamic intraventricular gradients. A thorough understanding of mitral valve anatomy and its role in left ventricular outflow tract obstruction is also crucial. Finally, anatomical variants of the mitral valve, papillary muscles and left ventricular myocardium are examined for their contribution to systolic anterior motion and mid-ventricular obstruction as well as for constituting additional phenotypical expressions of HCM, beyond left ventricular hypertrophy.

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