The Utility of Nuclear Imaging in Hypertrophic Cardiomyopathy: A Narrative Review

Hypertrophic cardiomyopathy (HCM) is the most common genetically inherited cardiac condition, characterized by clinical heterogeneity and a significantly increased risk of adverse cardiovascular outcomes, including sudden cardiac death. Current diagnostic methods primarily use echocardiography, often supplemented by cardiovascular magnetic resonance imaging (MRI), to assess the clinical profile of the disorder. Effective risk stratification protocols are essential for managing patients with HCM. These models rely on patient histories, imaging findings, and genetic information to evaluate the prognosis. Important factors in risk assessment include severe left ventricular hypertrophy (>30 mm), late gadolinium enhancement (>15%), or the presence of an apical aneurysm. However, these imaging techniques may lack sensitivity when it comes to detecting ischemia or microvascular dysfunction. Nuclear imaging methods, such as single-photon emission computed tomography (SPECT) and positron emission tomography (PET), offer a more comprehensive analysis of HCM. They provide valuable insights into the complex physiological mechanisms underlying the disease and facilitate early detection of functional abnormalities. This is particularly important for identifying high-risk phenotypes and understanding associated risk factors that may increase morbidity or mortality. This narrative review focuses on the role of nuclear imaging in the context of hypertrophic cardiomyopathy.