Overview
Hypertrophic cardiomyopathy (HCM) is characterized by left ventricular hypertrophy in the absence of other potentially causative cardiac, systemic, syndromic, or metabolic diseases 2. Symptoms can be related to various pathophysiologic mechanisms, including diastolic dysfunction, ischemia, and arrhythmias 2.Diagnosis
Accurate diagnosis of HCM relies fundamentally on multimodality cardiovascular imaging 2.
Resting and stress imaging provide comprehensive and complementary information to clarify the mechanism(s) responsible for symptoms 2.
Clinical and imaging parameters are utilized in enhanced algorithms for sudden cardiac death (SCD) risk stratification 2.Management
Direct oral anticoagulants (DOACs) demonstrate good efficacy and a favorable safety profile compared to vitamin K antagonists (VKAs) in patients with concurrent HCM and atrial fibrillation 1.
Multimodality imaging is fundamental for guiding appropriate and timely treatment strategies 2.
Enhanced algorithms using clinical and imaging parameters facilitate the selection of HCM patients most likely to benefit from implantable cardioverter-defibrillators (ICDs) 2.Key Recommendations
Multimodality cardiovascular imaging is fundamental for accurate diagnosis and longitudinal care of patients with hypertrophic cardiomyopathy 2. (Evidence: Expert opinion)
Clinical and imaging parameters should be used to enhance algorithms for sudden cardiac death risk stratification, facilitating selection of HCM patients for implantable cardioverter-defibrillators 2. (Evidence: Moderate)
Direct oral anticoagulants (DOACs) are recommended over vitamin K antagonists (VKAs) for patients with concurrent hypertrophic cardiomyopathy and atrial fibrillation due to their good efficacy and favorable safety profile 1. (Evidence: Moderate)References
1 Aboutorabi M, Ahmad M, Flora K, Ferreira H, Chiu M, Bray JJH et al.. Direct oral anticoagulants versus vitamin K antagonists in concurrent hypertrophic cardiomyopathy and atrial fibrillation: a meta-analysis. Expert review of cardiovascular therapy 2025. link
2 Nagueh SF, Phelan D, Abraham T, Armour A, Desai MY, Dragulescu A et al.. Recommendations for Multimodality Cardiovascular Imaging of Patients with Hypertrophic Cardiomyopathy: An Update from the American Society of Echocardiography, in Collaboration with the American Society of Nuclear Cardiology, the Society for Cardiovascular Magnetic Resonance, and the Society of Cardiovascular Computed Tomography. Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography 2022. link