# Multimodality imaging in hypertrophic cardiomyopathy

## TL;DR

This paper reviews how different imaging techniques help diagnose and manage hypertrophic cardiomyopathy by providing detailed heart structure and function insights.

## Contribution

The paper emphasizes the importance of combining multiple imaging modalities for a comprehensive evaluation of hypertrophic cardiomyopathy.

## Key findings

- Transthoracic echocardiography is the primary tool for assessing heart morphology and function.
- Cardiac magnetic resonance improves detection of myocardial fibrosis and complex heart structures.
- An integrated imaging approach enhances diagnosis and treatment decisions in HCM patients.

## Abstract

Hypertrophic cardiomyopathy (HCM) is a myocardial disorder characterized by unexplained myocardial hypertrophy. Although the diagnosis of HCM is traditionally based on increased left ventricular (LV) wall thickness, contemporary management requires a comprehensive multimodality imaging approach to accurately define disease phenotype, assess functional consequences, and guide risk stratification. Transthoracic echocardiography remains the first-line imaging modality, providing real-time evaluation of LV morphology, systolic and diastolic function, and LV outflow tract obstruction (LVOTO). However, its ability to assess myocardial tissue characteristics and complex morphologic variants may be limited in selected patients. Cardiac magnetic resonance (CMR) offers superior spatial resolution and allows detection of myocardial fibrosis using late gadolinium enhancement. Cardiac computed tomography serves as a complementary tool for evaluating coronary artery anatomy and detailed cardiac structure, particularly in patients with suboptimal echocardiographic windows or contraindications to CMR. This review summarizes the strengths and limitations of each imaging modality and highlights their complementary roles in the evaluation of cardiac morphology, systolic and diastolic function, LVOTO, and tissue characterization. An integrated imaging strategy is essential for optimized diagnosis, individualized risk stratification, and informed therapeutic decision-making in patients with HCM.

The online version contains supplementary material available at 10.1186/s44348-025-00060-7.