The Role of the Submitral Apparatus in Hypertrophic Obstructive Cardiomyopathy

J Am Soc Echocardiogr. 2023 Feb;36(2):133-145. doi: 10.1016/j.echo.2022.09.018. Epub 2022 Sep 30.

Abstract

Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiovascular disease, is characterized by unexplained hypertrophy of any myocardial segment, and has a prevalence of 0.2% to 0.5% among the general population. As one of the phenotypes of hypertrophic cardiomyopathy, left ventricular outflow tract obstruction (LVOTO) is associated with high morbidity and mortality, including cardiac death. The integration of various factors, including septal hypertrophy, malformation of the mitral valve apparatus, and an anomalous mitral subvalvular apparatus, may contribute to the occurrence of LVOTO. Previous studies have thoroughly discussed the role of the mitral valve in the mechanisms of systolic anterior motion and LVOTO. Recent studies have shown the importance of determining the potential mechanism of the submitral apparatus in inducing systolic anterior motion and LVOTO. The authors review recent advances in knowledge regarding the submitral apparatus of patients with hypertrophic cardiomyopathy.

Keywords: Hypertrophic cardiomyopathy; Left ventricular outflow tract obstruction; Submitral apparatus.

Publication types

  • Review

MeSH terms

  • Cardiomyopathy, Hypertrophic* / complications
  • Cardiomyopathy, Hypertrophic* / diagnosis
  • Humans
  • Hypertrophy / complications
  • Mitral Valve / diagnostic imaging
  • Myocardium
  • Ventricular Outflow Obstruction* / diagnostic imaging
  • Ventricular Outflow Obstruction* / etiology
  • Ventricular Outflow Obstruction, Left*