Abstract
Multimodality imaging is a comprehensive strategy to investigate left ventricular hypertrophy (LVH), providing morphologic, functional, and often clinical information to clinicians. Hypertrophic cardiomyopathy (HCM) is defined by an increased LV wall thickness not only explainable by abnormal loading conditions. In the context of HCM, multimodality imaging, by different imaging techniques, such as echocardiography, cardiac magnetic resonance, cardiac computer tomography, and cardiac nuclear imaging, provides essential information for diagnosis, sudden cardiac death stratification, and management. Furthermore, it is essential to uncover the specific cause of HCM, such as Fabry disease and cardiac amyloidosis, which can benefit of specific treatments. This review aims to elucidate the current role of multimodality imaging in adult patients with HCM.
Highlights
Left ventricular hypertrophy (LVH) is characterized by the increase of LV mass in response to different stimuli caused by various conditions and diseases [1]
Cardiac amyloidosis (CA) is caused by extracellular deposition of insoluble fibrils determining multifactorial myocardial damage, LV wall thickening, and early systolic and diastolic dysfunction leading to heart failure [28]
Cardiac scintigraphy with Tc99m-bone-avid radiotracers (PYP, HMDP or DPD) is highly specific in detecting transthyretin cardiac amyloidosis (ATTR-CA) [102,103]
Summary
Left ventricular hypertrophy (LVH) is characterized by the increase of LV mass in response to different stimuli (physical, biochemical, or genetic) caused by various conditions and diseases [1]. Echocardiography, being non-invasive and repeatable, has a fundamental role in Echocardiography detecting the different LVH/HCM phenotypes, suggesting disease causes, cardiac morphology and hemodynamic, and disease severity, all steps necessary in clinical. HCM caused by mutations in sarcomeric genes must be differentiated by other conditions which may mimic HCM phenotype but show a different aetiology and treatment [4,5,9,24,25,26,27] In this paragraph, we will focus on cardiac amyloidosis and Fabry disease, which represent possible causes of non-sarcomeric HCM in adult and elderly patients (Table 1). Myocardial Work Indices; LVOTO, Left Ventricular Outflow Tract Obstruction; MR, Mitral Regurgitation; MWT, Maximal Wall Thickness; SAM, Systolic Anterior Movement of Mitral Valve; TDI, Tissue Doppler Imaging
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