Hypertrophic Cardiomyopathy

  • Anita Sadeghpour
  • Azin Alizadehasl


Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiovascular disorder (autosomal dominant transmission), with primary involvement of the cardiac muscle. If associated with left ventricular outflow tract (LVOT) obstruction, it is called hypertrophic obstructive cardiomyopathy (HOCM).

HCM is characterized by localized or generalized unexplained left ventricular hypertrophy (LVH) in the non-dilated ventricle in the absence of any cardiac or systemic disease that can result in this magnitude of hypertrophy.

Usually, LV wall thickness is ≥15 mm in adults and ratio of IVS thickness to posterior wall thickness is ≥1.3/1. Systolic anterior motion (SAM) is the abnormal movement (sharp bending) of the anterior mitral valve (MV) leaflet toward the interventricular septum during systole.

LVOT obstruction happens as a result of both significant septal thickening and concomitant SAM of the mitral leaflets into the LVOT. Continuous-wave Doppler flow of the LVOT is characteristically dagger shaped and has a late-peaking velocity due to an increased obstruction as systole progresses. MR due to SAM is a mid-to-late systolic, eccentric, and posteriorly directed jet.

Several studies in patients with HCM have demonstrated a significant reduction in longitudinal strain (particularly in the mid-septal segment) with normal systolic twist or torsion.


Hypertrophic cardiomyopathy Hypertrophic obstructive cardiomyopathy Left ventricular outflow tract obstruction Asymmetric septal hypertrophy Systolic anterior motion 



Two dimensional


Three dimensional


Atrial fibrillation


Asymmetric septal hypertrophy


Coronary artery disease


Cardiac magnetic resonance


Computed tomography


Peak E-wave velocity of the mitral valve (cm/s)


TDI of the mitral annulus


Ejection fraction


Functional class


Hypertrophic cardiomyopathy


Hypertensive heart disease


Hypertrophic obstructive cardiomyopathy


Implantable cardioverter defivrillators


Left atrium


Late gadolinium enhancement


Left ventricular


Left ventricular ejection fraction


Left ventricular hypertrophy


Left ventricular outflow tract


Nonsustained ventricular tachycardia


New York Heart Association


Right ventricle


Systolic anterior motion


Sudden cardiac death


Speckle-tracking echocardiography


Tissue Doppler imaging


Transesophageal echocardiography


Transthoracic echocardiography

Supplementary material

Movie 22.1

(related to Fig. 22.2): ASH and SAM in para-sternal long axis view; SAM is best appreciated in the MV M-mode recordings of parasternal long-axis views (AVI 7146 kb)

Movie 22.2

MR due to SAM is a mid-to-late systolic, eccentric, and posteriorly directed jet (which is a common finding in HOCM) (AVI 808 kb)


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Anita Sadeghpour
    • 1
  • Azin Alizadehasl
    • 2
  1. 1.Professor of CardiologyEchocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical ScienceTehranIran
  2. 2.Associate Professor of Cardiology, Echocardiologist, Echocardiography and Cardiogenetic Research CentersCardio-Oncology Department, Rajaie Cardiovascular Medical and Research CenterTehranIran

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