Objective To investigate the incidence of localized myocardial hypertrophy in different parts of the left ventricular wall and the relationship between left ventricular pseudotendinous and localized myocardial hypertrophy. Methods Two-dimensional ultrasound was used to measure the wall thickness, the number of thickest and thinnest ventricular wall segments, and the number of thickened ventricular wall segments in 52 patients with localized myocardial hypertrophy, and to statistically analyze the differences in the incidence of thickest and thickened segments and the positive rate of pseudotendinous attachment sites in different ventricular wall thicknesses. In the group with focal myocardial hypertrophy, the thickest segment had the highest incidence at the base of the septum, followed by the apical segment of the left ventricular lateral wall; the rate of positive pseudotendinous attachment points was significantly higher in the base of the septum and the apical segment of the left ventricular lateral wall than in the other ventricular segments. The difference between the positive rate of pseudotendinous attachment sites in thickened segments and those in non-thickened segments was statistically significant (54/71 versus 66/761, x2=233.47, P<0.0001); the positive rate of pseudotendinous attachment sites in thickened segments (76.1%) compared with those in the thinnest segments (2.5%) was statistically significant in the localized myocardial hypertrophy group. The difference was statistically significant (x2=84.7, P<0.001); the positive rate of pseudotendon attachment sites in the thickened segments of localized myocardial hypertrophy was statistically significant (x2=8.4, P=0.04) compared with that in the thickest segments (94.3%). Conclusion Although local myocardial thickening involves multiple causes and its mechanisms are difficult to elucidate, it is undeniable that the pseudotendinous attachment site is a vulnerable site for myocardial hypertrophy and that the pulling of the pseudotendinous cord on the local ventricular wall may be one of the combined factors in the pathogenesis of local myocardial thickening. It is believed that this study will have an impact on the treatment of localized myocardial hypertrophy.