PMC9251991_01
Transthoracic echocardiogram strain assessment demonstrating antero-septal strain.
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A TTE demonstrated an LV ejection fraction of 67% (suggesting preserved LV ejection fraction), an LV internal diastolic diameter of 4.4 (suggesting a preserved internal diastolic diameter; normal range is from 3.5 to 6.5 cm), with an estimated right ventricular systolic pressure of 40 mm Hg (suggesting elevated pulmonary artery pressures; normal is <36 mm Hg), the LV outflow tract gradient was less than 30 mm Hg (gradient greater than 30 mm Hg marks the diagnosis of obstructive HCM) and reduced strain on the antero-septal region of the LV with a global longitudinal strain of -15% (suggests depressed LV function; normal is >-18%) (Figure 1).
Cardiac magnetic resonance (RV: right ventricle, LV: left ventricle, IVS: interventricular septum). (A) Post-gadolinium contrast short axis showing abnormal delayed enhancement in the basal to mid antero-septal wall in the subepicardial, mid myocardial region. Red line is bordering the left ventricular wall (endocardium), blue line is bordering the right ventricular wall (endocardium), the space between the blue and red line is the myocardium (orange arrow). Blue arrow is pointing the subepicardial region. (B) Steady-state free precision short axis demonstrating asymmetric thickening of the left ventricular wall in the antero-septal wall up to 17 mm. Red line is bordering the left ventricular wall (endocardium), blue line is bordering the right ventricular wall (endocardium), and the myocardial wall between the left ventricle and right ventricular is known as the interventricular septum.
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These findings are all suggestive of asymmetric HCM (Figure 2A and B).