Abstract
Hypertrophic cardiomyopathy (HCM) is a common, often genetic, cardiomyopathy that is characterized by substantial heterogeneity. Cardiovascular magnetic resonance (CMR), with its high spatial resolution and tomographic imaging capability, has emerged as an imaging modality particularly well suited to characterize the diverse phenotypic expression in this disease. CMR allows for accurate diagnosis of HCM and differentiating HCM from other causes of left ventricular (LV) hypertrophy. CMR plays a critical role in risk stratification and prevention of sudden death in HCM, identifying important risk markers including massive LV hypertrophy, LV apical aneurysms, end-stage HCM, and extensive late gadolinium enhancement, with one or more of these risk markers is associated with a higher risk of sudden death and deserving consideration for primary prevention implanted cardioverter defibrillators. CMR also aids in management of LV outflow obstruction by defining outflow tract anatomy and guiding pre-procedural surgical planning for surgical septal myectomy. The 20-year experience of CMR in HCM has helped transform HCM into a contemporary treatable disease associated with low mortality rates for the vast majority of patients.