“Speckled” Ventricular Septum in Hypertrophic Cardiomyopathy Revisited After 30 Years

We found a highly inconsistent relation between the granular and reflective ultrasound (“speckling”) pattern frequently observed in the ventricular septum of patients with hypertrophic cardiomyopathy and evidence of myocardial fibrosis by contrast-enhanced cardiovascular magnetic resonance imaging. Therefore, this distinctive echocardiographic appearance of the myocardium does not accurately characterize left ventricular scarring and is most likely explained as an extraneous ultrasound signal pattern. In conclusion, myocardial fibrosis in patients with hypertrophic cardiomyopathy is most reliably identified using contrast-enhanced cardiovascular magnetic resonance imaging.