Hypertrophic cardiomyopathy (HCM) is a frequently recognized condition on echocardiography. The apical variant, also known as 'Japanese variant', is rare and often poses a diagnostic challenge. There has been a resurgence of interest in the diagnosis of HCM especially with the advent of novel imaging modalities such as strain imaging. Two-dimensional (2D) strain echocardiography calculates tissue velocities via frame-to-frame tracking of acoustic markers within the image and provides strain parameters comparable with tissue-Doppler-derived strain. We describe paradoxical apical strain (systolic lengthening) without overt apical dyskinesis (conventional imaging) in two patients with apical HCM, using 2D strain imaging. Our report highlights a novel application of 2D strain imaging that could facilitate the diagnosis of apical HCM.
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