Potential value of myocardial contrast echocardiography for the detection of myocardial fibrosis in hypertrophic cardiomyopathy

Abstract

MOTS CLES Echocardiographie de contraste ; Imagerie par We report the case of a 37-year-old man with hypertrophic cardiomyopathy. Echocardiography showed a left ventricular hypertrophy (LVH) on the septal area (25 mm), without intraventricular obstruction or systolic anterior motion of the mitral valve. Myocardial contrast echocardiography showed an unusual capture of the contrast in the anteroseptal wall of the left ventricle, 5 minutes after injection of Sonovue® (Bracco Diagnostics, Inc., Princeton, NJ, USA; Fig. 1). Two weeks later, magnetic resonance imaging (MRI) was performed to confirm the LVH predominantly on the septal area (25 mm). Myocardial mass was 335 g. Delayed enhancement MRI studies (10 minutes after gadolinium injection) showed a delay-enhancement on the septal wall of the left ventricle, with an excellent topographic match with the abnormal contrast retention seen on echocardiography. The late enhancement was patchy and located predominantly in the subendocardium and not in the intramyocardium, which is more usual in LVH (Fig. 2). To rule out ischaemic cardiopathy, cardiac computed tomography was performed, which was normal. Delayed enhancement MRI studies can show late myocardial enhancement in hyper-