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European Journal of Echocardiography Advance Access published online on August 27, 2008
European Journal of Echocardiography, doi:10.1093/ejechocard/jen227
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Utility of tissue characterization in apical hypertrophic cardiomyopathy diagnosis

João Abecasis*, Raquel Dourado, Isabel Arroja, José Azevedo and Aniceto Silva

Cardiologia, Centro Hospitalar de Lisboa Ocidental, Rua Professor Reynaldo dos Santos, 2795-523 Carnaxide, Portugal

Received 16 March 2008; accepted after revision 8 August 2008.

* Corresponding author. Tel: +351914054977 (J.A.)/+351914952818 (R.D.); fax: +351214241388 E-mail address: joaoabecasis{at}hotmail.com (J.A.)/raqueldourado{at}yahoo.com (R.D.).


  Abstract

A 60-year-old male with previous hypertension, left ventricle hypertrophy, and coronary artery disease was referred for stress echocardiography because of exertional chest pain. The electrocardiogram revealed deep T-wave inversion in the anterolateral leads. Contrast echocardiography was notable for an apical filling defect consistent with the apical form of hypertrophic cardiomyopathy. Cardiac magnetic resonance demonstrated the ‘ace of spades’ left ventricle cavity, confirming the diagnosis. Single photon emission computed tomography showed increased apical left ventricle tracer uptake. Velocity vector imaging study depicted lower than normal absolute maximal longitudinal tissue velocities. The apical longitudinal strain was negative without base to apex gradient. There were normal longitudinal strain values in the basal and mid myocardial segments (Figure 1). Apical hypertrophic cardiomyopathy is a rare condition occasionally missed by conventional echocardiographic studies. Intravenous contrast enhancement might improve diagnosis accuracy. Newer Doppler-based techniques allowing tissue characterization may complement contrast echocardiography in its diagnosis.

Keywords: Apical hypertrophic cardiomyopathy; Velocity vector imaging; Tissue characterization


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