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Final Program


Program-At-A-Glance

Quick Fire Session

Session: Quick Fire Session 3: Cardiac Masses / Pericardial Disease/Cardiomyopathy (Monitor 16)

Saw-Tooth Cardiomyopathy: a case report

Friday, February 6, 2026
10:43 AM - 10:50 AM  
Location: Galapagos / Aruba / Ilhabela (2nd Lower Level)
Description of Clinical Presentation: Saw tooth cardiomyopathy is a rare form of left ventricular dysplasia, marked by multiple compacted myocardial projections that create a characteristic saw tooth pattern on noninvasive imaging. Only a limited number of cases have been documented, and this cardiomyopathy may appear either incidentally or in conjunction with symptoms of heart failure. We report the case of a 45 year old patient, born and raised in São Paulo, Brazil, without comorbidities, active, with regular physical activity, asymptomatic, under investigation for routine exams. The electrocardiogram showed sinus rhythm, with isolated ventricular extrasystole. The echocardiogram showed a slight increase in the left ventricle, with mild systolic dysfunction (LVEF 43%, with akinesia of the apex, mid and distal lateral wall, inferolateral and distal inferior wall). Coronary CT angiography showed no lesions, calcium score zero. He also underwent a cardiac MRI in 2021, which revealed left ventricular dilation with moderate left ventricular systolic dysfunction (LVEF 45%) with apex dyskinesia, hypokinesia of the entire apical and mid-lateral portions, left ventricular apical aneurysm with multiple muscular projections into the left ventricle, predominantly in the inferior, anterior, and lateral walls, in addition to myocardial crypts. Late transmural enhancement was present in the apex and apical lateral segment. The patient underwent genetic testing , which did not reveal any specific mutations, and the patient is currently receiving pharmacological treatment for heart failure.

Diagnostic Techniques and Their Most Important Findings: The cardiac MRI in 2021 revealed left ventricular dilation with moderate left ventricular systolic dysfunction (LVEF 45%) with apex dyskinesia, hypokinesia of the entire apical and mid-lateral portions, left ventricular apical aneurysm with multiple muscular projections into the left ventricle, predominantly in the inferior, anterior, and lateral walls, in addition to myocardial crypts. Late transmural enhancement was present in the apex and apical lateral segment.

Learning Points from this Case: Saw-tooth cardiomyopathy is an uncommon form of left ventricular cardiomyopathy, defined by numerous projections extending from the interventricular septum and attaching to the ventricular wall, resulting in a characteristic “saw-tooth” pattern on imaging studies. This summary reviews clinical findings from the past decade, aiming to improve future recognition and diagnosis of this condition by healthcare professionals. Cardiac magnetic resonance imaging plays a crucial role in the detection, characterization, and ongoing monitoring of such cases, offering high-resolution detail that is essential for accurate diagnosis and management.

saw tooth projections in a cine 4 chamber view
late gadolinium enhancement in the four-chamber view in the apical lateral segment
late gadolinium enhancement in the short axis view in the apical lateral segment