avkАрхивъ внутренней медициныThe Russian Archives of Internal Medicine2226-67042411-6564“SINAPS” LLC10.20514/2226-6704-2023-13-4-282-293PRXSRDavk-1639Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLEОсобенности гипертрофии левого желудочка и характеристика фенотипических вариантов у больных гипертрофической кардиомиопатиейSpecifics of Left Ventricular Hypertrophy and Characteristic of Phenotypic Variants in Patients with Hypertrophic Cardiomyopathyhttps://orcid.org/0000-0003-3611-1186ИгнатенкоГ. А.IgnatenkoG. I.

Донецк

Donetsk

https://orcid.org/0000-0003-3984-8482ТарадинГ. Г.TaradinG. G.

Геннадий Геннадьевич Тарадин

Донецк

Gennady G. Taradin

Donetsk

taradin@inbox.ruhttps://orcid.org/0000-0001-5547-6741КуглерТ. Е.KuglerT. E.

Донецк

Donetsk

ФГБОУ ВО Донецкий государственный медицинский университет им. М. Горького Минздрава РоссииРоссияThe Federal State-Funded Educational Institution of Higher Education Donetsk State Medical University named after M. GorkyRussian Federation202316082023134282293Copyright © Игнатенко Г.А., Тарадин Г.Г., Куглер Т.Е., 20232023Игнатенко Г.А., Тарадин Г.Г., Куглер Т.Е.Ignatenko G.I., Taradin G.G., Kugler T.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.medarhive.ru/jour/article/view/1639

Гипертрофическая кардиомиопатия характеризуется генетической и фенотипической гетерогенностью, что проявляется в различных вариантах локализации и протяженности гипертрофии миокарда.

Цель

Цель. На основании данных эхокардиографии оценить особенности гипертрофии левого желудочка, распространенность и клинико-инструментальные показатели фенотипических вариантов гипертрофической кардиомиопатии.

Материалы и методы

Материалы и методы. Обследовано 295 больных с гипертрофической кардиомиопатией в возрасте от 18 до 88 лет (60,3±13,4 лет), мужчин 183 (62 %), женщин 112 (38 %). Диагноз устанавливался на основании двухмерной эхокардиографии. Оценивались выраженность, локализация и протяженность гипертрофии миокарда, максимальная толщина гипертрофированного сегмента, масса миокарда, индекс массы миокарда левого желудочка, наличие и выраженность среднежелудочковой обструкции и обструкции выносящего тракта левого желудочка. В зависимости от преимущественной локализации и протяженности гипертрофии больные были распределены в 8 групп согласно рекомендациям по гипертрофической кардиомиопатии МЗ РФ. Проведен анализ и сравнение полученных результатов в зависимости от фенотипа кардиомиопатии.

Результаты

Результаты. Средняя продолжительность заболевания — 10,5±7,52 лет. Средние значения индекса массы тела у всех пациентов составили 28,2±2,82 кг/м2. Наиболее часто отмечался фенотип с базальной гипертрофией межжелудочковой перегородки (n=130, 44,1 %), 1 группа. У 47 (15,9 %) больных выявлена гипертрофия межжелудочковой перегородки «обратной кривизны» (3 гр.), у 41 (13,9 %) — «нейтральная межжелудочковая перегородка» (2 гр.), у 36 (12,2 %) — симметричная гипертрофия левого желудочка (8 гр.), по 11 (3,7 %) пациентов имели комбинированную гипертрофию межжелудочковой перегородки и других отделов левого или правого желудочка (4 гр.) и свободной стенки ЛЖ (7 гр.), у 10 (3,4 %) — среднежелудочковая гипертрофия левого желудочка (6 гр.) и у 9 (3,1 %) — апикальная гипертрофия (5 гр.). Наибольшее значение максимальной толщины миокарда отмечено у больных 6 группы 19,3 (1920,4 мм). Среднежелудочковая обструкция выявлена в 6 группе (90,0 %), обструкция выносящего тракта левого желудочка чаще регистрировалась в 4 и 8 группах (81,8 % и 77,8 %), а реже — в группе 5 (22,2 %) (р <0,01). У больных 7 группы не было выявлено случаев с обструкцией выносящего тракта левого желудочка в базальном состоянии. Максимальные значения показателей массы миокарда и индекса массы миокарда левого желудочка отмечены в группе 8 — 402 (356-439) г и 195 (173-218) г/м2, соответственно (p <0,01).

Заключение

Заключение. Эхокардиография представляет информативный метод оценки наличия, выраженности гипертрофии миокарда и определения фенотипического варианта гипертрофической кардиомиопатии. Наиболее часто регистрируются варианты гипертрофии межжелудочковой перегородки, среди которых самым распространенным является фенотип гипертрофии базальной её части. Каждый фенотип гипертрофической экспрессии характеризуется особенностями эхокардиографических параметров.

Hypertrophic cardiomyopathy is characterized by genetic and phenotypic heterogeneity which manifests in different variants of localization and extent of myocardial hypertrophy.

Aim

Aim: to evaluate specifics of left ventricular hypertrophy, the prevalence and characteristics of clinical and instrumental features of phenotypic variants of hypertrophic cardiomyopathy.

Materials and methods

Materials and methods. The study includes 295 patients with hypertrophic cardiomyopathy aged 18 to 88 years (60.3±13.4 years), 183 men (62 %), and women 112 (38 %). The diagnosis of which was established by 2D echocardiography. The severity, localization and extent of myocardial hypertrophy, the maximum thickness of the hypertrophied segment, left ventricular myocardial mass, left ventricular myocardial mass index, the presence and severity of mid-ventricular and left ventricular outflow tract obstruction were evaluated. Depending on the predominant localization and extent of hypertrophy, patients were divided into 8 groups according to the recommendations for hypertrophic cardiomyopathy of the Ministry of Health of the Russian Federation. The analysis and comparison of the obtained results are carried out.

Results

Results. The average duration of the disease is 10.5±7.52 years. The mean values of the body mass index in patients — 28.2±2.82 kg/m2. The phenotype with basal hypertrophy of the septum (n=130, 44.1 %), group 1 was most often noted. In 47 (15.9 %) patients, hypertrophy of the septum of “reverse curve” (2 group) was detected, in 41 (13.9 %) — “neutral septum” (3 group), in 36 (12.2 %) — symmetrical hypertrophy of the left ventricle (8 group), 11 (3.7 %) of patients had combined hypertrophy of the septum and other parts of the left or right ventricle (4 group) and the free left ventricular wall (7 group), in 10 (3.4 %) — middle ventricular hypertrophy of the left ventricle (6 group) and in 9 (3.1 %) — apical hypertrophy (5 group). The highest value of the maximum thickness of the myocardium was noted in patients of the 6th group 19.3 (1920.4 mm). Mid-ventricular obstruction was detected in group 6 (90 %), left ventricular outflow tract obstruction was more often registered in groups 4 and 8 (81.8 % and 77.8 %), and less often in group 5 (22.2 %) (p <0.01). In group 7, there were no cases of rest obstruction of left ventricular outflow tract. The maximum values of myocardial mass and left ventricular myocardial mass index were noted in group 8 — 402 (356-439) g and 195 (173218) g/m2, respectively (p <0.01).

Conclusion

Conclusion. Echocardiography is an informative tool for assessing the presence, severity myocardial hypertrophy and determination of the phenotypic variant of hypertrophic cardiomyopathy. Variants of septal hypertrophy are most commonly registered one, among which the most frequent is the phenotype of basal septal hypertrophy. Each phenotype of hypertrophic expression is characterized by its echocardiographic parameters.

гипертрофическая кардиомиопатиягипертрофия миокардафенотипэхокардиографияобструкцияhypertrophic cardiomyopathymyocardial hypertrophyphenotypeechocardiographyobstructionReferencesElliott PM, Anastasakis A, Borger MA, et al. 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J. 2014;35(39):2733-2779. doi: 10.1093/eurheartj/ehu284.Elliott PM, Anastasakis A, Borger MA, et al. 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J. 2014;35(39):2733-2779. doi: 10.1093/eurheartj/ehu284.Ommen SR, Mital S, Burke MA, et al. 2020 AHA/ACC guideline for the diagnosis and treatment of patients with hypertrophic cardiomyopathy: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2020:CIR0000000000000938. doi: 10.1161/CIR.0000000000000938.Ommen SR, Mital S, Burke MA, et al. 2020 AHA/ACC guideline for the diagnosis and treatment of patients with hypertrophic cardiomyopathy: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2020:CIR0000000000000938. doi: 10.1161/CIR.0000000000000938.Габрусенко С.А., Гудкова А.Я., Козиолова Н.А. и др. Гипертрофическая кардиомиопатия. Клинические рекомендации. 2020 Российский кардиологический журнал. 2021;26(5):4541. doi: 10.15829/1560-4071-2021-4541Gabrusenko S.A., Gudkova A.Y., Koziolova N.A., et al. 2020 Clinical practice guidelines for Hypertrophic cardiomyopathy. Russian Journal of Cardiology. 2021;26(5):4541. (In Russ.) doi: 10.15829/1560-4071-2021-4541Ватутин Н.Т., Тарадин Г.Г., Марон М.С. Гипертрофическая кардиомиопатия: генетические изменения, патогенез и патофизиология. Российский кардиологический журнал. 2014;(5):35-42. doi: 10.15829/1560-4071-2014-5-35-42Vatutin N.T., Taradin G.G., Maron M.S. Hypertrophic cardiomyopathy: genetic alterations, pathogenesis and pathophysiology. Russian Journal of Cardiology. 2014;(5):35-42. (In Russ.) doi: 10.15829/1560-4071-2014-5-35-42Haland TF, Edvardsen T. The role of echocardiography in management of hypertrophic cardiomyopathy. J Echocardiogr. 2020;18(2):77-85. doi: 10.1007/s12574-019-00454-9. 8.Haland TF, Edvardsen T. The role of echocardiography in management of hypertrophic cardiomyopathy. J Echocardiogr. 2020;18(2):77-85. doi: 10.1007/s12574-019-00454-9. 8.Syed IS, Ommen SR, Breen JF, et al. Hypertrophic cardiomyopathy: identification of morphological subtypes by echocardiography and cardiac magnetic resonance imaging. JACC Cardiovasc Imaging. 2008;1(3):377-9. doi: 10.1016/j.jcmg.2008.02.008.Syed IS, Ommen SR, Breen JF, et al. Hypertrophic cardiomyopathy: identification of morphological subtypes by echocardiography and cardiac magnetic resonance imaging. JACC Cardiovasc Imaging. 2008;1(3):377-9. doi: 10.1016/j.jcmg.2008.02.008.Klues HG, Schiffers A, Maron BJ. Phenotypic spectrum and patterns of left ventricular hypertrophy in hypertrophic cardiomyopathy: morphologic observations and significance as assessed by twodimensional echocardiography in 600 patients. J Am Coll Cardiol. 1995;26(7):1699-708. doi: 10.1016/0735-1097(95)00390-8.Klues HG, Schiffers A, Maron BJ. Phenotypic spectrum and patterns of left ventricular hypertrophy in hypertrophic cardiomyopathy: morphologic observations and significance as assessed by twodimensional echocardiography in 600 patients. J Am Coll Cardiol. 1995;26(7):1699-708. doi: 10.1016/0735-1097(95)00390-8.Parato VM, Antoncecchi V, Sozzi F, et al. Echocardiographic diagnosis of the different phenotypes of hypertrophic cardiomyopathy. Cardiovasc Ultrasound. 2016;14(1):30. doi: 10.1186/s12947-016-0072-5.Parato VM, Antoncecchi V, Sozzi F, et al. Echocardiographic diagnosis of the different phenotypes of hypertrophic cardiomyopathy. Cardiovasc Ultrasound. 2016;14(1):30. doi: 10.1186/s12947-016-0072-5.Rowin EJ, Maron BJ, Maron MS. The hypertrophic cardiomyopathy phenotype viewed through the prism of multimodality imaging: clinical and etiologic implications. JACC Cardiovasc Imaging. 2020;13(9):2002-2016. doi: 10.1016/j.jcmg.2019.09.020.Rowin EJ, Maron BJ, Maron MS. The hypertrophic cardiomyopathy phenotype viewed through the prism of multimodality imaging: clinical and etiologic implications. JACC Cardiovasc Imaging. 2020;13(9):2002-2016. doi: 10.1016/j.jcmg.2019.09.020.Nagueh SF, Phelan D, Abraham T, et al. Recommendations for multimodality cardiovascular imaging of patients with hypertrophic cardiomyopathy: an update from the American Society of Echocardiography, in collaboration with the American Society of Nuclear Cardiology, the Society for Cardiovascular Magnetic Resonance, and the Society of Cardiovascular Computed Tomography. J Am Soc Echocardiogr. 2022 Jun;35(6):533-569. doi: 10.1016/j.echo.2022.03.012.Nagueh SF, Phelan D, Abraham T, et al. Recommendations for multimodality cardiovascular imaging of patients with hypertrophic cardiomyopathy: an update from the American Society of Echocardiography, in collaboration with the American Society of Nuclear Cardiology, the Society for Cardiovascular Magnetic Resonance, and the Society of Cardiovascular Computed Tomography. J Am Soc Echocardiogr. 2022 Jun;35(6):533-569. doi: 10.1016/j.echo.2022.03.012.Mitchell C, Rahko PS, Blauwet LA, et al. Guidelines for performing a comprehensive transthoracic echocardiographic examination in adults: recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr. 2019; 32(1):1-64. doi: 10.1016/j.echo.2018.06.004.Mitchell C, Rahko PS, Blauwet LA, et al. Guidelines for performing a comprehensive transthoracic echocardiographic examination in adults: recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr. 2019; 32(1):1-64. doi: 10.1016/j.echo.2018.06.004.Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015;28(1):1-39.e14. doi: 10.1016/j.echo.2014.10.003.Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015;28(1):1-39.e14. doi: 10.1016/j.echo.2014.10.003.Maron BJ, Gottdiener JS, Epstein SE. Patterns and significance of distribution of left ventricular hypertrophy in hypertrophic cardiomyopathy. A wide angle, two dimensional echocardiographic study of 125 patients. Am J Cardiol. 1981;48(3):418-28. doi: 10.1016/00029149(81)90068-0.Maron BJ, Gottdiener JS, Epstein SE. Patterns and significance of distribution of left ventricular hypertrophy in hypertrophic cardiomyopathy. A wide angle, two dimensional echocardiographic study of 125 patients. Am J Cardiol. 1981;48(3):418-28. doi: 10.1016/00029149(81)90068-0.Maron MS, Maron BJ, Harrigan C, et al. Hypertrophic cardiomyopathy phenotype revisited after 50 years with cardiovascular magnetic resonance. J Am Coll Cardiol. 2009;54(3):220-8. doi: 10.1016/j.jacc.2009.05.006.Maron MS, Maron BJ, Harrigan C, et al. Hypertrophic cardiomyopathy phenotype revisited after 50 years with cardiovascular magnetic resonance. J Am Coll Cardiol. 2009;54(3):220-8. doi: 10.1016/j.jacc.2009.05.006.Stachera M, Przybyło P, Sznajder K, et al. Cardiac magnetic resonance in the assessment of hypertrophic cardiomyopathy phenotypes and stages — pictorial review. Polish Journal of Radiology. 2021; 86(1):672-684. doi:10.5114/pjr.2021.112310.Stachera M, Przybyło P, Sznajder K, et al. Cardiac magnetic resonance in the assessment of hypertrophic cardiomyopathy phenotypes and stages — pictorial review. Polish Journal of Radiology. 2021; 86(1):672-684. doi:10.5114/pjr.2021.112310.Kitai T, Xanthopoulos A, Nakagawa S, et al. Contemporary diagnosis and management of hypertrophic cardiomyopathy: the role of echocardiography and multimodality imaging. J Cardiovasc Dev Dis. 2022 May 25;9(6):169. doi: 10.3390/jcdd9060169.Kitai T, Xanthopoulos A, Nakagawa S, et al. Contemporary diagnosis and management of hypertrophic cardiomyopathy: the role of echocardiography and multimodality imaging. J Cardiovasc Dev Dis. 2022 May 25;9(6):169. doi: 10.3390/jcdd9060169.Binder J, Ommen SR, Gersh BJ, et al. Echocardiography-guided genetic testing in hypertrophic cardiomyopathy: septal morphological features predict the presence of myofilament mutations. Mayo Clin Proc. 2006 Apr;81(4):459-67. doi: 10.4065/81.4.459.Binder J, Ommen SR, Gersh BJ, et al. Echocardiography-guided genetic testing in hypertrophic cardiomyopathy: septal morphological features predict the presence of myofilament mutations. Mayo Clin Proc. 2006 Apr;81(4):459-67. doi: 10.4065/81.4.459.Helmy SM, Maauof GF, Shaaban AA, et al. Hypertrophic cardiomyopathy: prevalence, hypertrophy patterns, and their clinical and ECG findings in a hospital at Qatar. Heart Views. 2011 Oct;12(4):143-9. doi: 10.4103/1995-705X.90900.Helmy SM, Maauof GF, Shaaban AA, et al. Hypertrophic cardiomyopathy: prevalence, hypertrophy patterns, and their clinical and ECG findings in a hospital at Qatar. Heart Views. 2011 Oct;12(4):143-9. doi: 10.4103/1995-705X.90900.Oliveira DC, Assunção FB, Santos AA, et al. Cardiac magnetic resonance and computed tomography in hypertrophic cardiomyopathy: an update. Arq Bras Cardiol. 2016 Aug;107(2):163-72. doi: 10.5935/abc.20160081.Oliveira DC, Assunção FB, Santos AA, et al. Cardiac magnetic resonance and computed tomography in hypertrophic cardiomyopathy: an update. Arq Bras Cardiol. 2016 Aug;107(2):163-72. doi: 10.5935/abc.20160081.Baxi AJ, Restrepo CS, Vargas D, Marmol-Velez A, Ocazionez D, Murillo H. Hypertrophic cardiomyopathy from A to Z: genetics, pathophysiology, imaging, and management. Radiographics. 2016 MarApr;36(2):335-54. doi: 10.1148/rg.2016150137.Baxi AJ, Restrepo CS, Vargas D, Marmol-Velez A, Ocazionez D, Murillo H. Hypertrophic cardiomyopathy from A to Z: genetics, pathophysiology, imaging, and management. Radiographics. 2016 MarApr;36(2):335-54. doi: 10.1148/rg.2016150137.Muresan ID, Agoston-Coldea L. Phenotypes of hypertrophic cardiomyopathy: genetics, clinics, and modular imaging. Heart Fail Rev. 2021;26(5):1023-1036. doi: 10.1007/s10741-020-09931-1.Muresan ID, Agoston-Coldea L. Phenotypes of hypertrophic cardiomyopathy: genetics, clinics, and modular imaging. Heart Fail Rev. 2021;26(5):1023-1036. doi: 10.1007/s10741-020-09931-1.Maron MS, Maron BJ. Clinical impact of contemporary cardiovascular magnetic resonance imaging in hypertrophic cardiomyopathy. Circulation. 2015;132:292-298. DOI: 10.1161/CIRCULATIONAHA.114.014283.Maron MS, Maron BJ. Clinical impact of contemporary cardiovascular magnetic resonance imaging in hypertrophic cardiomyopathy. Circulation. 2015;132:292-298. DOI: 10.1161/CIRCULATIONAHA.114.014283.Maron BJ, Maron MS. The remarkable 50 years of imaging in HCM and how it has changed diagnosis and management: from M-mode echocardiography to CMR. JACC Cardiovasc Imaging. 2016; 9(7):858-872. doi: 10.1016/j.jcmg.2016.05.003.Maron BJ, Maron MS. The remarkable 50 years of imaging in HCM and how it has changed diagnosis and management: from M-mode echocardiography to CMR. JACC Cardiovasc Imaging. 2016; 9(7):858-872. doi: 10.1016/j.jcmg.2016.05.003.Preveden A, Golubovic M, Bjelobrk M, et al. Gender related differences in the clinical presentation of hypertrophic cardiomyopathy — an analysis from the SILICOFCM Database. Medicina (Kaunas). 2022;58(2):314. doi: 10.3390/medicina58020314.Preveden A, Golubovic M, Bjelobrk M, et al. Gender related differences in the clinical presentation of hypertrophic cardiomyopathy — an analysis from the SILICOFCM Database. Medicina (Kaunas). 2022;58(2):314. doi: 10.3390/medicina58020314.Argirò A, Ho C, Day SM, et al. Sex-related differences in genetic cardiomyopathies. J Am Heart Assoc. 2022;11(9):e024947. doi: 10.1161/JAHA.121.024947.Argirò A, Ho C, Day SM, et al. Sex-related differences in genetic cardiomyopathies. J Am Heart Assoc. 2022;11(9):e024947. doi: 10.1161/JAHA.121.024947.Sreenivasan J, Lloji A, Khan MS, Hooda U, Malik A, Sharma D, Shah A, Aronow WS, Michos ED, Naidu SS. Impact of body mass index on mortality in hospitalized patients with hypertrophic cardiomyopathy. Am J Cardiol. 2022;175:106-109. doi: 10.1016/j.amjcard.2022.04.011.Sreenivasan J, Lloji A, Khan MS, Hooda U, Malik A, Sharma D, Shah A, Aronow WS, Michos ED, Naidu SS. Impact of body mass index on mortality in hospitalized patients with hypertrophic cardiomyopathy. Am J Cardiol. 2022;175:106-109. doi: 10.1016/j.amjcard.2022.04.011.Butt AK, Alkhatib D, Pour-Ghaz I, et al. Hypertrophic cardiomyopathy. J Cardiovasc Dev Dis. 2023 Mar 2;10(3):106. doi: 10.3390/jcdd10030106.Butt AK, Alkhatib D, Pour-Ghaz I, et al. Hypertrophic cardiomyopathy. J Cardiovasc Dev Dis. 2023 Mar 2;10(3):106. doi: 10.3390/jcdd10030106.Maron BJ, Desai MY, Nishimura RA, et al. Management of hypertrophic cardiomyopathy: JACC State-of-the-Art Review. J Am Coll Cardiol. 2022;79(4):390-414. doi: 10.1016/j.jacc.2021.11.021.Maron BJ, Desai MY, Nishimura RA, et al. Management of hypertrophic cardiomyopathy: JACC State-of-the-Art Review. J Am Coll Cardiol. 2022;79(4):390-414. doi: 10.1016/j.jacc.2021.11.021.Theis JL, Bos JM, Bartleson VB, et al. Echocardiographic-determined septal morphology in Z-disc hypertrophic cardiomyopathy. Biochem Biophys Res Commun. 2006 Dec 29;351(4):896-902. doi: 10.1016/j.bbrc.2006.10.119.Theis JL, Bos JM, Bartleson VB, et al. Echocardiographic-determined septal morphology in Z-disc hypertrophic cardiomyopathy. Biochem Biophys Res Commun. 2006 Dec 29;351(4):896-902. doi: 10.1016/j.bbrc.2006.10.119.Minami Y, Kajimoto K, Terajima Y, et al. Clinical implications of midventricular obstruction in patients with hypertrophic cardiomyopathy. J Am Coll Cardiol. 2011;57(23):2346-55. doi: 10.1016/j.jacc.2011.02.033.Minami Y, Kajimoto K, Terajima Y, et al. Clinical implications of midventricular obstruction in patients with hypertrophic cardiomyopathy. J Am Coll Cardiol. 2011;57(23):2346-55. doi: 10.1016/j.jacc.2011.02.033.Losi MA, Nistri S, Galderisi M, et al; Working Group of Echocardiography of the Italian Society of Cardiology. Echocardiography in patients with hypertrophic cardiomyopathy: usefulness of old and new techniques in the diagnosis and pathophysiological assessment. Cardiovasc Ultrasound. 2010 Mar 17;8:7. doi: 10.1186/1476-7120-8-7.Losi MA, Nistri S, Galderisi M, et al; Working Group of Echocardiography of the Italian Society of Cardiology. Echocardiography in patients with hypertrophic cardiomyopathy: usefulness of old and new techniques in the diagnosis and pathophysiological assessment. Cardiovasc Ultrasound. 2010 Mar 17;8:7. doi: 10.1186/1476-7120-8-7.

The authors declare that there are no conflicts of interest present.