PDF Hypertrophic Cardiomyopathy (HCM)
[Pages:90]Hypertrophic Cardiomyopathy (HCM)
Evaluation and Differential Diagnosis
Role of Echocardiography
William K. Freeman, MD, FACC, FASE
DISCLOSURES
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Hypertrophic Cardiomyopathy
Echocardiographic Diagnosis
Left Ventricular Hypertrophy 15 mm (Asymmetric >> Symmetric)
In the absence of another cardiovascular or systemic disease associated with LVH or myocardial wall thickening
Gersh, BJ, et al. JACC 2011; 58: e212 ACC/AHA Guidelines
Hypertrophic Cardiomyopathy
Echocardiographic Diagnosis
Not Mandatory for Diagnosis of HCM
? Asymmetric Septal Hypertrophy (ASH) ? Systolic Anterior Motion (SAM) ? Dynamic LVOT obstruction
Hypertrophic Cardiomyopathy
Distribution of LVH (600 Patients)
Anterior septum only
(25%)
Septum & ant lat freewall (17%)
Septum & all freewalls (17%)
Anterior and inferior septum
(31%)
Klues HG, JACC 1995; 26: 1699
Lateral freewall
(1%)
Anterior septum & ant lat freewall
(7%) Apex only
(2%)
Left Ventricular Morphology in HCM
Sigmoid Septum
Reverse Septum
Neutral Septum
Apical Variant
181(47%) Gene + (8%)
132(35%) Gene + (79%)
32(8%) Gene + (41%)
Binder J, et al. Mayo Clin Proc 2006; 81: 459.
37(10%) Gene + (32%)
Genetic testing for HCM
Mayo Clinic Database (389 Patients)
? Echocardiographic anatomic
phenotypes are not specific for individual gene mutations
? Specific gene mutations not
predictive of prognosis or need for myectomy
Van Driest SL, et al. Mayo Clin Proc 2005; 80: 739
LVH in HCM: Sigmoid Septum
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