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Figure 1 A representative example of evolution to dilated-hypokinetic hypertrophic cardiomyopathy (HCM) in a female pediatric patient. (A) The basal echocardiogram (at age 13 years) shows HCM with massive left ventricular (LV) hypertrophy involving the intraventricular septum and the left posterior wall, accompanied by diminutive LV cavity size. (B) Three years later (at age 16 years), the LV cavity has become enlarged and the walls have thinned in the context of severe heart failure, requiring heart transplantation.