Hypothetical model for the pathogenesis of the end-stage phase of hypertrophic cardiomyopathy with left ventricular wall thinning and cavity enlargement

* Indicates the following possibilities: 1) enhanced myocardial oxygen requirements and reduced myocardial capillary density relative to marked left ventricular hypertrophy (LVH); and 2) increased diastolic wall tension and coronary vascular resistance resulting from abnormal LV relaxation and impaired filling.