4Dimensional XStrain Echocardiography: Comprehensive Evaluation of Non-obstructive Hypertrophic Cardiomyopathy- A Case Report and Review of Literature

Hypertrophic cardiomyopathy (HCM) is a relatively common inherited cardiomyopathy, which is occasionally challenging to differentiate from hypertensive heart disease and athletes heart on the basis of morphologic or functional abnormalities alone. Imaging studies provide solution for majority of clinical presentations. Generally, transthoracic echocardiography (TTE) is employed as a first line imaging tool and contrast enhanced echocardiography (CEE), contrast tuned imaging echocardiography (CTIE), cardiac magnetic resonance (CMR), cardiac computed tomography (CCT), cardiac nuclear imaging and speckle tracking echocardiography (STE) are encouraged for either suboptimal studies because of poor visualization of left ventricular (LV) cavity or for comprehensive delineation of the cardiac anatomy, its widespread left and right ventricular involvement, associations and complications. We are reporting a case of 48-year old male presenting to us with atypical chest pain and a history of suspicious solitary episode of syncope. His routine ECG was indicative of left ventricular hypertrophy with strain pattern, and his TTE was substandard and inadequate in the apical four chamber (4CH) and five chamber (5CH) views, hence CTIE was performed without the application of intravenous contrast agents, to produce a remarkable illustration of HCM. Keywords: Hypertrophic cardiomyopathy, contrast echocardiography, contrast tuned imaging, speckle tracking echocardiography, 4Dimensional XStrain, Non obstructive HCM