Introduction
Diagnosis
HCM diagnosis |
LV wall thickness ≥ 15 mm by any imaging modality |
If HCM related mutation: LV wall thickness ≥ 13 mm |
Left ventricular outflow tract obstruction and mitral valve
Left ventricular outflow tract obstruction |
1. 1/3 are non-obstructive |
2. 1/3 are obstructive (peak Doppler pressure gradient ≥ 30 mmHg at rest) |
3. 1/3 are labile-obstructive with significant gradient during provocation or exercise |
4. Pharmacological provocation is not recommended |
5. Gradient of ≥ 50 mmHg is considered of hemodynamical importance |
6. Myectomy or alcohol septal ablation (ASA) should be considered if the patients have moderate to severe symptoms and a gradient ≥ 50 mmHg |
Systolic function
LV systolic function |
1. EF is typically preserved in HCM patients despite significant impairment of longitudinal systolic LV function |
2. EF is therefore not adequate to evaluate medical treatment and cardiac transplantation |
3. GLS by speckle-tracking echocardiography is an accurate measure of systolic function |
4. Speckle-tracking echocardiography reveals subtle changes in systolic function in genotype-positive relatives |
Diastolic function
Diastolic dysfunction with elevated LVEDP is present in HCM patients if > 50% of the variables meet the cut-off values |
1. \( E/e^{\prime} \) > 14 |
2. LA volume index > 34 mL/m2 |
3. Pulmonary vein atrial reversal velocity (Ar-A duration ≥ 30 ms) |
TR peak velocity of > 2.8 m/s |
LA enlargement
Risk stratification |
HCM has an annual incidence of 1–2% sudden cardiac death. LV aneurysm increases risk of SCD and thromboembolic events |
Risk calculator by European Society of Cardiologya |
1. MWT |
2. LA size |
3. Maximal left outflow gradient |
4. + age, family history of SCD, syncope, non-sustained ventricular tachycardia |