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Figure 1 Late-onset left ventricular (LV) hypertrophy confined to the apical region, documented by serial echocardiography in a 60-year-old woman with familial hypertrophic cardiomyopathy (HCM) due to a myosin-binding protein C mutation. The patient has remained free of HCM-related cardiac symptoms. (A) Apical four-chamber cross-sectional view obtained at 55 years of age as part of a cardiac evaluation unrelated to HCM, showing the absence of LV hypertrophy with apical endocardium delineated by the broken line. (B) Similar echocardiographic cross-sectional plane, five years later, showing marked segmental hypertrophy confined to the LV apex (asterisk and broken line), which has developed over that period of time. LA = left atrium; MV = mitral valve; RA = right atrium; RV = right ventricle.
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