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Diagnostics
Volume 15
Issue 23
10.3390/diagnostics15233013
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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Review

Multimodality Imaging in Apical Hypertrophic Cardiomyopathy: Can Echocardiography Learn from Cardiac Magnetic Resonance?

by
Francesco Mangini
1,*,
Massimo Grimaldi
1,
Francesco Spinelli
2,
Santo Dellegrottaglie
3,
Antonio Di Monaco
1,
Simona Quarta
4,
Grazia Casavecchia
5,
Matteo Gravina
6,
Vincenzo Bellomo
1,
Luca Sgarra
1,
Sergio Suma
7,
Gaetano Citarelli
8,
Enrica Filograna
9,
Robert W. W. Biederman
10 and
Roberto Calbi
2
1
Cardiology Department, General Regional Hospital F. Miulli, 70021 Acquaviva delle Fonti, Italy
2
Radiology Department, General Regional Hospital F. Miulli, 70021 Acquaviva delle Fonti, Italy
3
Cardiology Department, Ospedale Accreditato Villa dei Fiori, 80011 Acerra, Italy
4
Cardiology Department, Ospedale Policlinico di Bari, Università degli Studi di Bari, 70121 Bari, Italy
5
Cardiology Department, Ospedali Riuniti Foggia, 71122 Foggia, Italy
6
Radiology Department, Ospedali Riuniti Foggia, 71122 Foggia, Italy
7
Cardiology Department, Azienda Ospedaliero Universitaria, 43126 Parma, Italy
8
Cardiology Section, Hospital “S. Paolo”, 70123 Bari, Italy
9
Imaging Diagnostics Center, 73048 Nardò, Italy
10
Department of Cardiology, Roper/St Francis Hospital, Charleston, SC 29414, USA
*
Author to whom correspondence should be addressed.
Diagnostics 2025, 15(23), 3013; https://doi.org/10.3390/diagnostics15233013 (registering DOI)
Submission received: 28 October 2025 / Revised: 18 November 2025 / Accepted: 23 November 2025 / Published: 26 November 2025
(This article belongs to the Special Issue Advances in Non-Invasive Diagnostic Technologies for Heart Diseases)
Versions Notes

Abstract

Apical hypertrophic cardiomyopathy is a distinctive and often under-recognized variant of hypertrophic cardiomyopathy, characterized by predominant thickening of the apical segments of the left ventricle. Echocardiography and cardiac magnetic resonance imaging represent the two principal modalities for diagnosis and morphological assessment. While transthoracic echocardiography remains the first-line imaging technique, it may underestimate apical involvement, particularly when image foreshortening or poor endocardial/epicardial delineation occurs. Cardiac magnetic resonance has become the reference standard for defining apical morphology, quantifying hypertrophy, and characterizing myocardial tissue and perfusion. Beyond its diagnostic role, magnetic resonance serves as a research platform for the identification of new apical-centric criteria which, after appropriate validation, may be translated into echocardiographic practice. Echocardiography, however, retains unique strengths through its real-time evaluation of cardiac dynamics, ready-to-use approach to diastolic function assessment, and its ability to identify subtle apical or para-apical obstructive gradients that may raise the initial diagnostic suspicion. This review underscores the complementary roles of the two modalities and the multiple domains in which transthoracic echocardiography can derive substantial methodological and conceptual benefit from cardiac magnetic resonance imaging, both in imaging methodology and in the refinement of diagnostic evaluation.
Keywords: cardiomyopathies; apical hypertrophic cardiomyopathy; multimodality imaging; echocardiography; cardiac magnetic resonance imaging cardiomyopathies; apical hypertrophic cardiomyopathy; multimodality imaging; echocardiography; cardiac magnetic resonance imaging

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MDPI and ACS Style

Mangini, F.; Grimaldi, M.; Spinelli, F.; Dellegrottaglie, S.; Di Monaco, A.; Quarta, S.; Casavecchia, G.; Gravina, M.; Bellomo, V.; Sgarra, L.; et al. Multimodality Imaging in Apical Hypertrophic Cardiomyopathy: Can Echocardiography Learn from Cardiac Magnetic Resonance? Diagnostics 2025, 15, 3013. https://doi.org/10.3390/diagnostics15233013

AMA Style

Mangini F, Grimaldi M, Spinelli F, Dellegrottaglie S, Di Monaco A, Quarta S, Casavecchia G, Gravina M, Bellomo V, Sgarra L, et al. Multimodality Imaging in Apical Hypertrophic Cardiomyopathy: Can Echocardiography Learn from Cardiac Magnetic Resonance? Diagnostics. 2025; 15(23):3013. https://doi.org/10.3390/diagnostics15233013

Chicago/Turabian Style

Mangini, Francesco, Massimo Grimaldi, Francesco Spinelli, Santo Dellegrottaglie, Antonio Di Monaco, Simona Quarta, Grazia Casavecchia, Matteo Gravina, Vincenzo Bellomo, Luca Sgarra, and et al. 2025. "Multimodality Imaging in Apical Hypertrophic Cardiomyopathy: Can Echocardiography Learn from Cardiac Magnetic Resonance?" Diagnostics 15, no. 23: 3013. https://doi.org/10.3390/diagnostics15233013

APA Style

Mangini, F., Grimaldi, M., Spinelli, F., Dellegrottaglie, S., Di Monaco, A., Quarta, S., Casavecchia, G., Gravina, M., Bellomo, V., Sgarra, L., Suma, S., Citarelli, G., Filograna, E., Biederman, R. W. W., & Calbi, R. (2025). Multimodality Imaging in Apical Hypertrophic Cardiomyopathy: Can Echocardiography Learn from Cardiac Magnetic Resonance? Diagnostics, 15(23), 3013. https://doi.org/10.3390/diagnostics15233013

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