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Imaging myocardial scar in hypertrophic cardiomyopathy: advances in CMR and CT

Matteo Sclafani1,2, Chiara Perrotti2, Luigi Salerno2

  • 1Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.

Frontiers in Cardiovascular Medicine
|October 6, 2025
PubMed

Insights

Myocardial scarring in hypertrophic cardiomyopathy (HCM) drives adverse outcomes. Advanced imaging like cardiovascular magnetic resonance (CMR) and cardiac computed tomography (CT) are vital for assessing this scar and guiding patient management.

Area of Science:

  • Cardiology
  • Medical Imaging

Background:

  • Myocardial scarring is a key feature of hypertrophic cardiomyopathy (HCM), contributing to adverse events like sudden cardiac death and heart failure.
  • The fibrotic tissue in HCM is complex, involving replacement and interstitial fibrosis, often with myocardial disarray.

Purpose of the Study:

  • To review the role of multimodality cardiovascular imaging in assessing myocardial scar in HCM.
  • To focus on cardiovascular magnetic resonance (CMR) and cardiac computed tomography (CT) for scar characterization and discuss their clinical implications.

Main Methods:

  • Cardiovascular magnetic resonance (CMR) techniques including late gadolinium enhancement, T1/T2 mapping, and diffusion tensor imaging.
  • Cardiac computed tomography (CT) methods such as delayed iodine enhancement and CT-derived extracellular volume mapping.

Main Results:

  • CMR is the established gold standard for non-invasive fibrosis assessment in HCM, offering detailed scar insights.
  • CT is an emerging modality providing valuable scar assessment, especially when CMR is not feasible.

Conclusions:

  • Multimodality imaging, particularly CMR and CT, is crucial for characterizing myocardial scar in HCM.
  • Accurate scar assessment aids in risk stratification and personalized management strategies for HCM patients.

Keywords:
cardiac computed tomography (CT)cardiovascular magnetic resonance (CMR)hypertrophic cardiomyopathy (HCM)late gadolinium enhancementmyocardial scar

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