Abstract
It is more than 50 years since the first modern description of hypertrophic cardiomyopathy (HCM).1 Understanding has been driven by technology, with the first descriptions focusing on clinical examination, ECG changes, and histological changes from autopsy study. As technology evolved from ventriculography, M-mode, then 2-dimensional echocardiography, and cardiovascular magnetic resonance (CMR), understanding has evolved and the known phenotype of the disease has extended. Recent notable examples of this have been hypertrophy missed by echo, particularly but not exclusively at the apex, mitral valve abnormalities, apical aneurysms, and proposed familial criteria, where even subtle abnormalities may be adjudged significant in the context of a pretest probability of 50% of genetic mutation carriage. In this issue of Circulation: Cardiovascular Imaging , Maron et al2 have explored the potential significance of myocardial crypts. These “architectural abnormalities” of the left ventricle (LV) occur particularly in the septum and inferior (posterior) right ventricular (RV) insertion point and had been observed at increased frequency in HCM. …
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