The Evolving Landscape of Hypertrophic Cardiomyopathy: Clinical Assessment, Precision Therapies, and Emerging Strategies
- 1Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35100 Padua, Italy
Abstract
Hypertrophic cardiomyopathy (HCM) is a genetically and phenotypically heterogeneous disease in which management requires integration of clinical assessment, cardiovascular physiology, multimodality imaging, functional evaluation, and arrhythmic risk. This review examines contemporary evaluation, risk stratification, and treatment of sarcomeric HCM across obstructive and non-obstructive phenotypes. In obstructive HCM, conventional negative inotropic therapy and septal reduction therapy remain established treatments, while cardiac myosin inhibitors have introduced a mechanism-based approach that improves left ventricular outflow tract obstruction, symptoms, and exercise capacity. Their role relative to septal reduction therapy should be individualized according to anatomy, hemodynamics, treatment burden, durability, and patient preference. In non-obstructive HCM, treatment remains largely symptom-directed, although recent trials of myosin inhibition have yielded divergent results, emphasizing the importance of appropriate patient selection. Emerging strategies targeting myocardial energetics and earlier disease stages may further expand treatment options. Gene-based therapies, including first-in-human MYBPC3 replacement, offer the possibility of targeting the underlying molecular defect but require careful evaluation of safety, durability, and timing. Overall, HCM remains a paradigmatic disease for physiology-driven, phenotype- and stage-specific care, increasingly complemented by molecularly targeted therapies.
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BibTeX
@article{parodi2026evolving,
title = {{The Evolving Landscape of Hypertrophic Cardiomyopathy: Clinical Assessment, Precision Therapies, and Emerging Strategies}},
author = {Alessandro Parodi and Beatrice Baù and Giorgio Piccolboni and Nicola Morat and Laura De Michieli and Marika Martini and Kalliopi Pilichou and Alberto Cipriani and Barbara Bauce and Chiara Calore},
journal = {Journal of Clinical Medicine},
year = {2026},
month = nov,
doi = {10.3390/jcm15218498},
url = {https://www.mdpi.com/2077-0383/15/21/8498},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - The Evolving Landscape of Hypertrophic Cardiomyopathy: Clinical Assessment, Precision Therapies, and Emerging Strategies
AU - Alessandro Parodi
AU - Beatrice Baù
AU - Giorgio Piccolboni
AU - Nicola Morat
AU - Laura De Michieli
AU - Marika Martini
AU - Kalliopi Pilichou
AU - Alberto Cipriani
AU - Barbara Bauce
AU - Chiara Calore
PY - 2026
DA - 2026/11/01
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218498
UR - https://www.mdpi.com/2077-0383/15/21/8498
AB - Hypertrophic cardiomyopathy (HCM) is a genetically and phenotypically heterogeneous disease in which management requires integration of clinical assessment, cardiovascular physiology, multimodality imaging, functional evaluation, and arrhythmic risk. This review examines contemporary evaluation, risk stratification, and treatment of sarcomeric HCM across obstructive and non-obstructive phenotypes. In obstructive HCM, conventional negative inotropic therapy and septal reduction therapy remain established treatments, while cardiac myosin inhibitors have introduced a mechanism-based approach that improves left ventricular outflow tract obstruction, symptoms, and exercise capacity. Their role relative to septal reduction therapy should be individualized according to anatomy, hemodynamics, treatment burden, durability, and patient preference. In non-obstructive HCM, treatment remains largely symptom-directed, although recent trials of myosin inhibition have yielded divergent results, emphasizing the importance of appropriate patient selection. Emerging strategies targeting myocardial energetics and earlier disease stages may further expand treatment options. Gene-based therapies, including first-in-human MYBPC3 replacement, offer the possibility of targeting the underlying molecular defect but require careful evaluation of safety, durability, and timing. Overall, HCM remains a paradigmatic disease for physiology-driven, phenotype- and stage-specific care, increasingly complemented by molecularly targeted therapies.
SN - 2077-0383
ER -