Hypertrophic cardiomyopathy (HCM) is a complex cardiac disorder that carries a risk of sudden cardiac death (SCD), particularly in certain high-risk individuals. Echocardiographic evaluation plays a crucial role in identifying risk factors for SCD, with guidelines from both American and European cardiology societies emphasising key markers such as extreme left ventricular hypertrophy, left ventricular outflow tract (LVOT) obstruction, and abnormal systolic function. Differentiating between obstructive and non-obstructive HCM is essential, as obstructive forms—characterised by dynamic LVOT obstruction—often require more aggressive management, including medications, surgical interventions, or septal ablation.

LVOT obstruction occurs when the thickened heart muscle, often in combination with systolic anterior motion (SAM) of the mitral valve, restricts blood flow out of the left ventricle. It is defined by a resting or provocable LVOT gradient of ≥30 mmHg, with severe obstruction exceeding 50 mmHg. Echocardiography, including Doppler assessment, is the gold standard for measuring this gradient. Additionally, diastolic dysfunction is a key aspect of HCM, as the stiffened heart muscle impairs relaxation and filling. Stress echocardiography is often used to unmask latent LVOT obstruction and assess functional capacity, further aiding in risk stratification and treatment planning.
Presenter Ada Lo