Multimodality cardiac imaging aids differentiation between hypertrophic cardiomyopathy and cardiac amyloidosis

This narrative review synthesizes evidence on the use of multimodality cardiac imaging—specifically echocardiography and cardiac MRI—to differentiate hypertrophic cardiomyopathy (HCM) from cardiac amyloidosis (CA) in patients presenting with myocardial thickening. The review does not report a specific sample size, study setting, or comparator, and it is based on a synthesis of existing literature rather than new patient data.

The review describes characteristic echocardiographic features for each condition. For HCM, these include asymmetric septal hypertrophy, dynamic left ventricular outflow tract obstruction, and systolic anterior motion of the mitral valve. For CA, features include concentric wall thickening, biatrial enlargement, restrictive filling, and an "apical sparing" strain pattern. On cardiac MRI, HCM is associated with patchy mid-wall or junctional fibrosis on late gadolinium enhancement (LGE), while CA shows diffuse LGE involving the subendocardium or full wall thickness. Mapping parameters show mildly elevated native T1 and extracellular volume (ECV) in HCM versus markedly increased values in CA. No quantitative effect sizes, absolute numbers, or statistical measures are reported for these findings.

Safety and tolerability data for the imaging modalities are not reported. Key limitations include the descriptive nature of the review, the lack of reported quantitative data or comparative performance metrics, and the absence of information on funding or conflicts of interest. The practice relevance is that differentiating HCM from CA is clinically crucial due to differing management strategies and prognoses, but this review provides a qualitative summary of imaging patterns rather than definitive diagnostic criteria.