In the patients with HCM, subtle LV deformation can be observed and measured clinically before the onset of general LV functional changes. Both hypertrophy and fibrosis influenced the extent of LV deformation. Our study demonstrated the 2D CS as a stable global parameter to assess LV functional and ECV changes. At the segmental level, hypertrophy and LGE (+) antagonistic affected 2D RS and diastolic RSR. Despite the excitement surrounding these pertinent clinical findings, further research is warranted as the mechanism of the phenomenon still needs to be explored.