Multimodality imaging in apical hypertrophic cardiomyopathy

Figure 1 On transthoracic echocardiography, apical hypertrophic cardiomyopathy is defined as an absolute apical thickness of more than 15 mm with a ratio of apical to basal left ventricular wall thickness of more than 1. 3. A: 12-lead electrocardiogram with increased in QRS voltage and deep T-wave inversion in the precordial leads; B: Transthoracic echocardiography 4-chambers view showing asymmetrical left ventricular apical thickening with a spade shaped left ventricle configuration.

Figure 2 Angiography pictures. A: Coronary angiography showing normal epicardial coronary arteries. Please note the presence of multiple coronary artery-left ventricular microfistulae (white arrow); B: Left ventricular angiography showing the characteristic diastolic “ace-of spade” sign.

Figure 3 Multidetector computed tomography imaging: Long axis view (A) and axial scans at the level of the left ventricle (B) showing apical hypertrophy with cavity obliteration and a sequestered small left ventricle cavity.

Figure 4 Cardiovascular magnetic resonance imaging. Long axis view (A) of the left ventricle showing apical regional hypertrophy; long axis view 10 min after Gadolinium injection; B: An abnormal hyper-enhancement of the apical segment is visible (white arrow).