Echocardiographic evaluation of hypertrophic cardiomyopathy: A review of up‐to‐date knowledge and practical tips

Anwar, Ashraf M.; TenCate, Folkert J.

doi:10.1111/echo.15200

Cited by 6 publications

(4 citation statements)

References 85 publications

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“…It is due to the narrowed LVOT producing a rapid acceleration of blood flow, inducing drag forces to attract the AML during mid and late systole. The result is a SAM of AML worsening LVOT gradient and an eccentric regurgitation jet, directed to the posterolateral wall of the left atrium ( 5 , 6 ).…”

Section: Discussionmentioning

confidence: 99%

“…The SAM can involve not only the mitral leaflet but also the chordae tendineae but usually, this condition alone is not able to produce a significant LVOT obstruction ( 6 ).…”

Section: Discussionmentioning

confidence: 99%

“…Hypertrophic cardiomyopathy (HCM) is the most frequent monogenic cardiac disease, with a prevalence of almost 1 in 500 individuals ( 1 – 4 ). In about 70% of patients with HCM, left ventricular (LV) outflow tract (LVOT) obstruction is due to both septal hypertrophy and pressure drop above the aortic valve (AV) leading to drag forces, attracting the anterior mitral leaflet (AML) and frequently causing significant mitral regurgitation (MR) ( 5 , 6 ). This kind of MR is called “systolic anterior motion (SAM)-dependent” and it is the most frequently related to HCM.…”

Section: Introductionmentioning

confidence: 99%

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Different mechanisms of mitral regurgitation in hypertrophic cardiomyopathy: A clinical case and literature review

Molisana¹,

Selimi²,

Gizzi³

et al. 2022

Front. Cardiovasc. Med.

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BackgroundAbnormalities of the mitral valve (MV) apparatus are typical features of hypertrophic cardiomyopathy (HCM). These abnormalities include leaflet elongation, thick leaflets, displacement of papillary muscle, and systolic anterior motion (SAM) of the MV anterior leaflet. Mitral valve chordal rupture associated with HCM is a rare but serious issue capable of change the clinical apparence and the prognosis of the patient.Case summaryA 57-year-old lady with a history of diabetes, dyslipidemia, and a previous single episode of atrial fibrillation (treated with pharmacological cardioversion), presented to the Emergency Department for worsening dyspnea (New York Heart Association Classification class IV). A trans-thoracic echocardiogram (TTE) showed a significant, septal, and asymmetric left ventricular hypertrophy (basal anteroseptal wall diastolic thickness of 19 mm) with normal left ventricle systolic function. A SAM of AML was evident together with a left ventricular outflow tract gradient of 56 mmHg at rest, rising to 136 mmHg during the Valsalva maneuver. In addition, there was evidence of moderate to severe mitral regurgitation (MR) with an anteriorly directed jet, not very typical of MR related to SAM. A 2D-3D trans-esophageal echocardiogram (2D-3D TEE) revealed a combined MR mechanism based on PML degenerative prolapse with P2-flail from ruptured chordae with related eccentric anteriorly directed regurgitant jet, together with a second regurgitant posteriorly directed jet, related to SAM of AML. The patient underwent MV repair together with septal myectomy, with a good final outcome.ConclusionPre-operative echocardiography (both TTE and 2D-3D TEE) is an essential tool in order to detect different MV abnormalities in patients with HCM. These types of patients should never be treated by septal reduction alone. Surgical MV repair or replacement, together with septal myectomy, may be the preferred approach.

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Section: Discussionmentioning

confidence: 99%

“…The SAM can involve not only the mitral leaflet but also the chordae tendineae but usually, this condition alone is not able to produce a significant LVOT obstruction ( 6 ).…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Different mechanisms of mitral regurgitation in hypertrophic cardiomyopathy: A clinical case and literature review

Molisana¹,

Selimi²,

Gizzi³

et al. 2022

Front. Cardiovasc. Med.

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“…HCM is typically diagnosed via echocardiography ( Anwar and TenCate, 2021 ; Schober et al ., 2022 ). The cutoff value for left ventricular wall hypertrophy when diagnosing HCM is 3 6 mm in cats ( Payne et al ., 2013 ) and 3 15 mm in humans ( Gersh et al ., 2011 ; Enriquez and Goldman, 2014 ); however, there is currently no accepted cutoff value in dogs given the significant variations in body size between dog breed.…”

Section: Introductionmentioning

confidence: 99%

Clinical findings using echocardiography and plasma cardiac troponin I and pathological findings in dogs with hypertrophic cardiomyopathy: A retrospective study

Ando¹,

Izawa²,

Nishida³

et al. 2023

Open Vet J

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Background: Hypertrophic cardiomyopathy (HCM) is considered rare in dogs, and there is a lack of clinical data. Cardiac troponin I (cTnI) is a biomarker of cardiomyocyte damage and necrosis and can be used to diagnose cat and human HCM. Aim: We investigated whether the presence of cTnI in clinical data can be used in conjunction with echocardiography to diagnose canine HCM. Methods: This study comprised client-owned dogs with clinical evidence of concentric hypertrophy on echocardiographic images, serum total thyroxine levels of ≤5 µg/dl, systolic blood pressure of ≤180 mmHg, and absence of aortic stenosis. All cases were necropsied. Results: Cardiomyocyte hypertrophy (mean diameter, 18.3 ± 1.8 µm), myocardial fiber disarray (70%), interstitial fibrosis (80%), and small vessel disease (100%) were assessed. In dogs with HCM, the left ventricles were concentric, almost symmetrical, and hypertrophied above the aortic diameter. The end-diastolic interventricular septum normalized to body weight [intraventricular septal thickness in diastole (IVSDN)] was 0.788 [interquartile range (IQR), 0.7–0.92], which exceeded the normal range (5%–95%, IQR: 0.33–0.52). In total, 70% of the dogs with HCM had syncope and dyspnea, and all dogs had high cTnI levels (median, 3.94 ng/ml), exceeding the upper limit of normal (0.11 ng/ml) and indicating cardiomyocyte damage. IVSDN and serum cTnI levels were correlated ( ρ = 0.839, p = 0.01). Conclusion: Ventricular wall thickening and high serum cTnI levels can provide a presumptive diagnosis of HCM and prompt the initiation of treatment or additional diagnostic investigations.

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Efficacy and safety of a transaortic approach to midventricular and apical septal myectomy

Maigrot,

Weiss,

Steely

et al. 2024

The Journal of Thoracic and Cardiovascular Surgery

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Echocardiographic evaluation of hypertrophic cardiomyopathy: A review of up‐to‐date knowledge and practical tips

Cited by 6 publications

References 85 publications

Different mechanisms of mitral regurgitation in hypertrophic cardiomyopathy: A clinical case and literature review

Different mechanisms of mitral regurgitation in hypertrophic cardiomyopathy: A clinical case and literature review

Clinical findings using echocardiography and plasma cardiac troponin I and pathological findings in dogs with hypertrophic cardiomyopathy: A retrospective study

Efficacy and safety of a transaortic approach to midventricular and apical septal myectomy

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