Seeing beneath the surface: Are current risk scores enough in hypertrophic cardiomyopathy?

The most solid advice I can give is this: always try to see beneath the surface.''Ernest Hemingway Risk stratification for sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM) has always been an exercise in approximation.Over the years, more sophisticated algorithms have sought to convert clinical heterogeneity into numerical risk estimates, giving clinicians a sense of precision and objectivity.Yet, despite successive updates to European and American guidelines, the essential question remains controversial but unavoidable: are we truly identifying the patients who will experience malignant ventricular arrhythmias, or merely those who fit our models?Current risk scores mainly depend on easily measurable factors ---wall thickness, gradients, arrhythmic surrogates (like left ventricular ejection fraction), and clinical history.While these variables certainly reflect aspects of disease