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Figure 3 Echocardiographic Diagnosis of Apical Hypertrophic Cardiomyopathy

(A) Contrast-enhanced images (Definity; Bristol-Myers Squibb Medical Imaging Inc., North Billerica, Massachusetts) of a patient with apical hypertrophic cardiomyopathy in end-diastole and (B) "ace of spades" appearance of the left ventricle cavity with apical cavity obliteration in end-systole. (C) Conventional apical 4-chamber view showing exuberant LVH (arrow) in apical HCM. (D) Two-dimensional strain (quad format) images of same patient showing paradoxical apical longitudinal strain (crimson segment and tracing) and corresponding perturbations in the color M-mode of the parametric strain map. Note loss of base-apex (strain) gradient.