Role of multimodal imaging in HCM: Thinking beyond fibrosis—A case report

Abstract Hypertrophic cardiomyopathy (HCM) is a prevalent inherited cardiac disorder characterized by diverse phenotypic and genetic expressions, leading to significant clinical complications and increased cardiovascular risk 1 . This case focuses on the problematic progression of a 50-year-old woman with non-obstructive HCM and acquired cardiovascular risk factors, culminating in severe systolic dysfunction and the development of an apical aneurysm. Transthoracic echocardiography (TTE) and cardiac magnetic resonance (CMR) revealed severe left ventricular (LV) systolic dysfunction, alongside significant myocardial fibrosis and viability, which guided prognostic therapeutic decisions, including myocardial revascularization and prophylactic implantable cardioverter-defibrillator (ICD) placement. This case illustrates the importance of using multimodal imaging in managing HCM.