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Hypertrophic cardiomyopathy

Session 106

Imaging techniques play an essential role in the evaluation of patients with hypertrophic cardiomyopathy (HCM), given the complexity and limitations of clinical assessment in these patients. Thus, in HCM patients, imaging provides solutions for most clinical needs. Some of these questions were discussed in this high scientific level session.

First, Prof S. Lafitte (FR) elegantly focused on imaging for preventive and therapeutic strategies in this disease. Based on a case study, he explained how imaging can be useful in the positive diagnosis of HCM, the differential diagnosis with phenocopies, sudden cardiac death risk stratification, family tracking, symptoms evaluation and for medical and invasive treatment.

Next, Prof S. E. Petersen (GB) clearly addressed the important topic of tissue characterization and discussed the major contributions of cardiovascular magnetic resonance (CMR). Specifically, the different CMR tools to characterize myocardial tissue and the added clinical value of tissue characterization in HCM were reviewed (early diagnosis, differential diagnosis, guiding and monitoring interventions and risk stratification). Additionally, the potential role of cardiac CT in patients with contra-indications to CMR was described.

The third speaker was Prof B. A. Popescu (Bucharest, RO) who explained the state of the art in the assessment of left and right ventricular systolic and diastolic function in HCM. He underlined the role of different echocardiography modalities, including 2D-echo, contrast echocardiography, blood pool and tissue Doppler imaging and 2D- speckle tracking echocardiography in the diagnosis, and in the determination of prognosis in this disease.

Finally, the integrated multimodality imaging approach in HCM patients was addressed by Prof. M. Galderisi (Naples, IT) who reviewed the recently published EACVI consensus on the use of multimodality imaging in HCM.

Accordingly, a multimodality imaging approach (including echocardiography, CMR, CCT, and cardiac nuclear imaging) is encouraged in the assessment of patients with this complex and fascinating disease. The choice of which technique to use should be based on a broad perspective and expert knowledge of what each technique has to offer, including its specific advantages and disadvantages.

All in all, experts in different imaging techniques should collaborate and the different methods should be seen as complementary, not as competitors. Each test must be selected in an integrated and rational way, in order to provide clear answers to specific clinical questions and problems, trying to avoid redundant and duplicated information, and taking into account availability, benefits, risks, and cost.

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.