A prospective observational study published in the Clinical Cardiology evaluated the utility of myocardial contrast echocardiography (MCE) in differentiating physiological and pathological myocardial hypertrophy through quantitative perfusion assessment. Between June 2023 and December 2024, 75 participants were enrolled, including 25 hypertensive patients with myocardial hypertrophy (pathological hypertrophy), 25 healthy athletes (physiological hypertrophy), and 25 healthy controls. 

All participants underwent two-dimensional echocardiography and MCE. Myocardial perfusion was quantified using a standardized 17-segment model, measuring peak intensity (A-value), wash-in slope (β-value), and myocardial blood flow (MBF). Receiver operating characteristic (ROC) analysis was performed to evaluate diagnostic performance.

Compared with controls, individuals with physiological hypertrophy demonstrated higher A-values and MBF (p<0.05), indicating enhanced perfusion. In contrast, the pathological hypertrophy group showed reduced A-value, β-value, and MBF (p<0.05). Segmental analysis within the pathological group revealed lower A-values and MBF in basal segments compared with mid and apical regions (p<0.05). 

Intermural comparisons indicated that in control and physiological groups, the free wall had lower A-values and MBF than the septum (p<0.05), whereas in pathological hypertrophy, the free wall showed reduced A-value but increased β-value (p<0.05). ROC analysis identified an optimal A-value threshold >8.13 dB for distinguishing physiological from pathological hypertrophy (area under the curve [AUC] 0.904).

MCE-derived perfusion parameters differed between physiological and pathological hypertrophy. Quantitative A-value demonstrated strong discriminatory performance between these conditions.