Hypertropic Cardiomyopathy


Introduction

 

This protocol is published in Echo Research and Practice and can be accessed directly via the following links

 

A systematic approach to echocardiography in hypertrophic cardiomyopathy (HTML)

A systematic approach to echocardiography in hypertrophic cardiomyopathy (PDF)

 

  VIEW MODALITY MEASUREMENTS EXPLANATORY NOTE IMAGE

PLAX

m mode

IVS

(i) IVS measure >3cm is a key marker of increased risk*

(ii) Demonstrate if ASH is present

(ii) Measure RV wall thickness if on axis.





Note: Ensure LV on axis for m mode measurements, if not, measure in 2D.

Avoid inclusion of papillary muscle/moderator band/trabeculations in measurement

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PLAX

m mode and CFD

MV leaflet tips and AoV leaflet tips



(i) Demonstrate if SAM is present on M Mode and for colour flow turbulence within the LVOT.

(ii) Demonstrate if early closure of the AoV







 



 

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PSAX MV

2D

Frozen 2D image: obtain wall thickness measurements from level of the basal LV.

Measure at 4 points, using clock face as reference (12, 3, 6, 9)



 





 



 

 





 



 

To assess for asymmetric and symmetric segmental LV hypertrophy

Segmental hypertrophy >1.5cm* with normal or small LV internal cavity dimensions is strongly suggestive of HCM (in absence of other pathologies i.e. HTN).

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PSAX PM

2D

2D frozen image at the mid LV level.

 



 



Measure at 4 points, using clock face as reference (12, 3, 6, 9)

Avoid off axis measurements, papillary muscle and trabeculations.



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PSAX Apex

2D

Apical level measure at 2 points (12 and 6 O'clock).



 

Apical hypertrophy may be present if apical/basal lateral ratio >1.5.

Consideration should be given to use of LVO contrast

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Modified PSAX

2D & PW/CW Doppler



 

RV wall thickness and RVOT forward flow velocities



Modify both the RV inflow and outflow to assess for RVH and RVOT obstruction. RVH present if >0.5cm.



 

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Modified Apical 4CH

2D

RV wall thickness

If clear measure RVH, otherwise preferred measurement from the PLAX and subcostal views. RVH present if >0.5cm.



 

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Apical 4CH & Apical 2CH

2D

LA Volume

Index LA volume to BSA**

A4C

CFD



Aetiology and severity of mitral regurgitation



If SAM present, MR may be eccentric and is usually mid/late systolic



A4C

PW Tissue Doppler



Systolic (Sa), early (Ea) and atrial (Aa) relaxation velocities at anterolateral LV annulus.



 





 



 

Reduction in Sa or Ea velocities below normal range for age and sex.***

Assess for elevated LVEDp by measuring E/Em. Average septal and lateral velocities for Em. Abnormal if >10.**

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A4C

PW Tissue Doppler

Systolic (Sa), early (Ea) and atrial (Aa) relaxation velocities at inferoseptal LV annulus.



 





 



 

Reduction in Sa or Ea velocities below normal range for age and sex.***

Assess for elevated LVEDp by measuring E/Em. Average septal and lateral velocities for Em. Abnormal if >10.**

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A5C & A4C

CFD

Locate turbulent flow both within the LV cavity and the LVOT.



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A5C & A3C

PW/HPRF/CW Doppler



Quantify LVOT/LV intracavity dynamic flow gradient



 

Sample PW Doppler throughout the LV cavity, paying particular attention to areas with turbulent flow. HPRF/CW Doppler may be appropriate if aliasing occurs. Take care not to include MR jet in sample volume!

Gradient >30mmHg is a marker of adverse prognosis.*

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A2C

PW Tissue Doppler



Systolic (Sa), early (Ea) and atrial (Aa) relaxation velocities at inferior LV annulus.



 





 



 

Reduction in Sa or Ea velocities below normal range for age and sex.***.



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A2C

PW Tissue Doppler

Systolic (Sa), early (Ea) and atrial (Aa) relaxation velocities at anterior LV annulus.



 





 



 

Reduction in Sa or Ea velocities below normal range for age and sex.***



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Copyright © 2011 British Society of Echocardiography