Fig. 3.

CMR imaging in a dual-chamber, secondary prevention ICD patient (female, 58 years) presenting with worsening heart failure symptoms 27.9 months after device implantation. Diagnostic change (+); management/treatment change (–): pre-CMR referral diagnosis: suspected myocardial storage disease; post-CMR diagnosis: hypertrophic cardiomyopathy; pre-CMR treatment plan: medical therapy; post-CMR treatment plan: medical therapy. A – D, on post–contrast cine imaging (cardiac standard geometries) LV septal hypertrophy was identified with normal regional wall motion/normal global systolic LV function (LVEF 59%); E – H, LGE CMR imaging demarcated the typical pattern of multifocal islands/patchy fibrosis in the interventricular septum while the remaining LV myocardium was normal. Approximate generator position is indicated by the asterisk