Details
From subtle wall thickening to diffuse infiltration — multimodality imaging tells the full story.
Echo → progressive concentric LVH + diastolic dysfunction
Strain → classic apical sparing pattern (93% sensitivity, 82% specificity)
CMR → subendocardial → transmural LGE with pathognomonic difficult nulling (sensitivity >85%)
Clinical Pearl: Apical sparing on GLS bull's-eye is impaired from the earliest disease phase — preceding overt systolic dysfunction. LGE progresses from subendocardial to transmural enhancement as disease advances. Don't wait for the advanced stage. Identify early. Treat decisively.