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Assessment of apical hypertrophic cardiomyopathy using transoesophageal echocardiography
J J Crowley1, P S Dardas, L M Shapiro
1Regional Cardiac Unit, Papworth Hospital, Cambridge, UK.
Insights
Multiplane transesophageal echocardiography offers superior imaging of the left ventricle apex compared to transthoracic echocardiography for diagnosing apical hypertrophic cardiomyopathy, revealing more accurate wall thickness measurements.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- Two-dimensional echocardiography is standard for hypertrophic cardiomyopathy.
- Transthoracic echocardiography often provides inadequate imaging of the left ventricular apex.
- Apical hypertrophic cardiomyopathy may be missed or underestimated with transthoracic echocardiography.
Purpose of the Study:
- To evaluate multiplane transesophageal echocardiography for diagnosing apical hypertrophic cardiomyopathy.
- To compare transesophageal echocardiography with transthoracic echocardiography in assessing apical hypertrophy.
Main Methods:
- Six patients with apical hypertrophic cardiomyopathy underwent both transthoracic and multiplane transesophageal echocardiography.
- Detailed assessment of left ventricular segments and papillary muscles was performed.
Main Results:
- Multiplane transesophageal echocardiography visualized hypertrophy in all 6 patients, with apical wall thickness ranging from 1.7-2.9 cm.
- Transthoracic echocardiography underestimated apical hypertrophy, imaging the apex in only 4 patients.
- Papillary muscle hypertrophy was detected by transesophageal echocardiography in 2 patients, but not by transthoracic echocardiography.
Conclusions:
- Transthoracic echocardiography has limitations in diagnosing apical hypertrophic cardiomyopathy due to inconsistent apical imaging.
- Multiplane transesophageal echocardiography provides high-resolution imaging of the entire left ventricle, including the apex.
- Transesophageal echocardiography offers a more accurate assessment of hypertrophy severity and distribution in apical hypertrophic cardiomyopathy.
Abstract:
Two-dimensional echocardiography is the method of choice for imaging and diagnosis in patients with hypertrophic cardiomyopathy. However, ultrasound examination of the left ventricular apex by transthoracic echocardiography is often inadequate so that hypertrophy localised to this region may be missed. The purpose of this study was to evaluate the use of multiplane transoesophageal echocardiography in the diagnosis and assessment of apical hypertrophic cardiomyopathy. Six patients with apical hypertrophic cardiomyopathy underwent transthoracic and multiple transoesophageal echocardiography. Assessment of the proximal left ventricle was possible in all patients by both techniques and normal wall thickness measurements were obtained. Assessment of the distal left ventricle by multiple transesophageal echococardiography revealed hypertrophy of the apex (range 1.7-2.9 cm) and less marked hypertrophy of the distal segments of the left ventricle in all 6 patients (1.4-2.2 cm). Examination of the papillary muscles was also possible and hypertrophy was detected in 2 patients. By transthoracic echocardiography, hypertrophy was detected in the distal left ventricle of 5 patients and values were less than those obtained by multiplane transoesophageal echocardiography. No papillary muscle hypertrophy was seen. The apical segment was imaged in only 4 patients and maximum thicknesses of the apical segment were greater by multiple transoesophageal echocardiographic examination than by transthoracic echocardiography (mean 2.25 +/- 0.4 and 1.97 +/- 0.3 cm, respectively). We conclude that apical hypertrophic cardiomyopathy may be difficult to diagnose using transthoracic echocardiography because of inconsistent imaging of the apical segment. The distribution of hypertrophy may be inappropriately assigned and the severity of wall thickening underestimated. Multiplane transoesophageal echocardiography allows high resolution imaging of all segments of the left ventricle, particularly the apex.