**2. Echo findings in cardiomyopathies**

For this review a modification of 1995 World Health Organization /International Society and Federation of Cardiology (WHO/ISFC) Task Force on the Definition and Classification of Cardiomyopathies [11] and 2006 American Heart Association classification of cardiomyo‐ pathic disorders [12] is used. Discussion on echocardiographic findings will be limited to more frequently encountered disorders and to conditions with unique echo features.

#### **2.1. Modified classification of primary and secondary cardiomyopathies**

**i.** Genetic:

in differentiation of physiologic hypertrophy in elite athletes from pathologic variants [6, 23], in assessment of myocardial dyssynchrony [7], and in differentiating constrictive from

Doppler-based strain imaging is limited by angle dependency [8]. Innovation in imaging hardware and software now permit tissue-based measurement of segmental, regional and global myocardial function by determining tissue strain and torsion (Figure-3). The technique relies on good 2-D image quality for tracking tissue characteristics, termed "speckles", in regions of interest on a 2-D image through the entire cardiac cycle. To improve spatial resolution, image acquisition is performed at a slower frame rate contrasting with higher frame rate of Doppler-based techniques [9]. This may influence the accuracy of time dependent measurement of myocardial function as in milder forms of left ventricular dyssynchrony. Potentially valuable clinical information can be derived from speckle strain in a variety of

**Figure 3.** Speckle strain measurement inlongitudinal and radial direction is performed.In Panel-A, longitudinal strain is determinedat multiple levels from base to apex. Because contraction in longitudinal direction results in fiber shorten‐ ing, strain values are negative. Segmental impairment of longitudinalstrain or contractility is present. In panel-B radial strain is depicted as a positive value due to fiber lengthening radially in systole. All segments at this level show normal

contractility.LV torsion can be determined from the same data set.

cardiac disorders, including asymptomatic stages of cardiomyopathy [9].

restrictive physiology.

6 Cardiomyopathies

**1.4. 2D or speckle strain and LV torsion**

	- **•** Dilated cardiomyopathy (DCM)
	- **•** Restrictive cardiomyopathy (non hypertrophied and non dilated) (RCM)
	- **•** Inflammatory myocarditis
	- **•** Stress provoked (takotsubo cardiomyopathy)
	- **•** Peripartum cardiomyopathy
	- **•** Tachycardia induced cardiomyopathy
	- **•** Ischemic cardiomyopathy
	- **•** Valvular cardiomyopathy
	- **•** Hypertensive cardiomyopathy
	- **•** Metabolic cardiomyopathy including amyloidosis and hemochromatosis
	- **•** Toxic cardiomyopathy: Alcohol and anthracyclines
	- **•** Connective Tissue Disorders: RA, SLE, PAN, scleroderma

Echo methods of estimating left ventricular end-diastolic pressure (E/E' ratio) show hetero‐

Echocardiography Findings in Common Primary and Secondary Cardiomyopathies

http://dx.doi.org/10.5772/55036

9

Systolic anterior motion of the anterior mitral leaflet with or without obstruction to flow across the left ventricular outflow tract is highly suggestive of HCM (Figure-4). This finding has a specificity of > 90% [20]. Of note, SAM may also be encountered in hypercontractile states, following mitral valve repair, with anomalous papillary muscle insertion, in patients with anteroapical infarction, in takotsubo cardiomyopathy who have hyperkinesia of basal left ventricularsegmentandinelderlywomenwithleftventricularhypertrophyandsigmoidshaped

**Figure 4.** In panel A marked asymmetric septal hypertrophy (ASH) is noted (asterisk) in parasternal long axis display. Systolic anterior motion (SAM) of the mitral valve is seen in panel B (arrow). Turbulence of blood flow through the left ventricular outflow tract (LVOT) associated with posteriorly directed mitral regurgitation due to LVOT obstruction from SAM is present (panel C). Spectral Doppler through the LVOT confirms LVOT obstruction with a late peaking gra‐ dient of 60 mmHg (panel D). In this example Valsalva maneuver was used to confirm dynamic LVOT obstruction.

geneity and lack specificity in HCM [19].

septum [21].

**Systolic Anterior Motion (SAM) of mitral valve:**
