**6. Conclusion**

hypertrophic cardiomyopathy are seen in 5% of cases. In contrast to a hypertrophied ventricle, low voltage in precordial leads is seen on ECG, and systolic anterior motion of mitral valve which is a frequent observation in hypertrophic cardiomyopathy on echo, is uncommon in patients with cardiac amyloidosis. By novel echo techniques longitudinal strain and strain rate show systolic dysfunction despite preserved radial contraction as determined by fractional shortening. The value of strain parameters in early diagnosis and in prognosis is being evaluated [72]. Furthermore, strain measurement by 2D speckle tracking shows variation in longitudinal strain from base to apex with relative preservation of apical strain. This finding can be helpful in distinguishing cardiac amyloidosis from hypertrophic cardiomyopathy and

**Figure 10.** Severe concentric left ventricular wall thickening and small pericardial effusion is present in this patient with cardiac amyloidosis (panel A). Impaired mitral annular velocity is indicative of abnormal diastolic function (re‐

There are no specific morphologic features on echocardiogram. Dilated cardiomyopathy is seen in advanced stages of hemochromatosis [74]. Non-invasive diagnosis of cardiac involve‐ ment is dependent on demonstration of myocardial iron deposit on cardiac MRI [75]. In cases with established cardiac involvement, assessment of myocardial kinetics by Doppler and tissue strain may reveal functional impairment prior to development of overt cardiomyopathy. The value of these new techniques in determining prognosis and in serial follow up of patients

Echo findings are non-specific. Dilated cardiomyopathy from cardiotoxicity of alcohol cannot be distinguished from idiopathic dilated cardiomyopathy. Impairment of left ventricle systolic function is a concern for both anthracycline and some non-anthracycline based chemothera‐

following therapeutic intervention has been the subject of recent studies.

duced mitral annular velocities with reversal of E' to A' ratio) (panel B).

**5.9. Toxic cardiomyopathy: Alcohol and anthracyclines**

*5.8.2. Hemochromatosis*

20 Cardiomyopathies

hypertrophy associated with increased afterload state of aortic stenosis [73].

Value of echocardiography in the diagnosis, prognosis and monitoring of therapy in patients with cardiomyopathy is discussed in the preceding review. 3DE, Doppler and speckle strain and left ventricular torsion may have a role in preclinical disease states. Incorporation of these diagnostic methods in routine clinical assessment of patients with cardiomyopathy is depend‐ ent on emerging data on the usefulness and reproducibility of these techniques.
