ECHO Parameters to Assess Hypertrophied Obstructive
Cardiomyopathy / Hypertrophied Cardiomyopathy
HCM is characterized by unexplained, marked and asymmetric LV hypertrophy associated with non-dilated
ventricular chambers in the absence of another cardiac or systemic disease capable of producing the
magnitude of hypertrophy evident in a given patient.
Approach for diagnosis Images
1. Confirming LV Hypertrophy
2D – PLAX and A4C
Unexplained max. Wall thickness >15mm in
any myocardial segment.
Septal and posterior wall thickness ratio >1.3
in normotensive patients
Septal and posterior wall thickness ratio >1.5
in hypertensive patients.
2D PSAX -Systolic obliteration of LV cavity.
2. Assessment of LVOT obstruction
Dynamic obstruction at rest and with Valsalva
maneuver to identify the site of obstruction and the
gradient
Seen in PLAX And A4C
Obstruction under resting conditions
(gradients ≥30 mm Hg).
labile, physiologically provoked gradients
(<30 mm Hg at rest and ≥30 mm Hg with
physiologic provocation)
non-obstructive form of HCM (gradients <30
mm Hg at rest and with provocation)
Marked gradients of >50mmHg (at rest or
with provocation can be threshold for
intervention).
Doppler - Dagger shaped pattern
For HOCM -
Mid-systolic closure of the aortic valve
Fibrotic changes at the level of leaflet- septal
contact
Coarse systolic fluttering of the aortic valve
3. Assessment of systolic anterior motion of the
mitral valve (SAM).
PLAX- Opposition of mitral leaflet
A5C– abnormal MV leaflet motion.
M mode – mid systolic notching of the AV and
contact AML /Chordae with the IVS
Grades of SAM :
Grade 1 - AML and septum distance >10 mm
Grade 2 - AML and septum distance <10 mm
Grade 3 - AML and septal contact <30% of systole
Grade 4 - AML and septal contact >30% of systole
4. Assessment of LV systolic function
Cardiomyopathy / Hypertrophied Cardiomyopathy
HCM is characterized by unexplained, marked and asymmetric LV hypertrophy associated with non-dilated
ventricular chambers in the absence of another cardiac or systemic disease capable of producing the
magnitude of hypertrophy evident in a given patient.
Approach for diagnosis Images
1. Confirming LV Hypertrophy
2D – PLAX and A4C
Unexplained max. Wall thickness >15mm in
any myocardial segment.
Septal and posterior wall thickness ratio >1.3
in normotensive patients
Septal and posterior wall thickness ratio >1.5
in hypertensive patients.
2D PSAX -Systolic obliteration of LV cavity.
2. Assessment of LVOT obstruction
Dynamic obstruction at rest and with Valsalva
maneuver to identify the site of obstruction and the
gradient
Seen in PLAX And A4C
Obstruction under resting conditions
(gradients ≥30 mm Hg).
labile, physiologically provoked gradients
(<30 mm Hg at rest and ≥30 mm Hg with
physiologic provocation)
non-obstructive form of HCM (gradients <30
mm Hg at rest and with provocation)
Marked gradients of >50mmHg (at rest or
with provocation can be threshold for
intervention).
Doppler - Dagger shaped pattern
For HOCM -
Mid-systolic closure of the aortic valve
Fibrotic changes at the level of leaflet- septal
contact
Coarse systolic fluttering of the aortic valve
3. Assessment of systolic anterior motion of the
mitral valve (SAM).
PLAX- Opposition of mitral leaflet
A5C– abnormal MV leaflet motion.
M mode – mid systolic notching of the AV and
contact AML /Chordae with the IVS
Grades of SAM :
Grade 1 - AML and septum distance >10 mm
Grade 2 - AML and septum distance <10 mm
Grade 3 - AML and septal contact <30% of systole
Grade 4 - AML and septal contact >30% of systole
4. Assessment of LV systolic function
