How to assess sudden cardiac death risk in hypertrophic cardiomyopathy? Current challenges and future directions.

Over the past decade, knowledge about the risk of sudden cardiac death (SCD) in patients with hypertrophic cardiomyopathy (HCM) has advanced significantly. A standard well-recognized approach to risk stratification is based on the fundamental risk factors and SCD risk models that should be incorporated into the shared decision-making process. More detailed analysis including additional indicators, such as reduced left ventricular systolic function, the presence of late gadolinium enhancement, or in some cases genetic variants, may provide valuable insights for intermediate-risk patients, enabling more personalized diagnosis and treatment. Risk stratification remains challenging in specific groups, such as patients who have undergone septal reduction therapy, those taking mavacamten, or those with phenocopies of HCM. The advancement of modern methodologies, including multifactorial approaches supported by artificial intelligence algorithms, offers hope for more precise and individualized SCD risk assessment in HCM patients.