Advances in Non-Invasive Myocardial Stiffness Assessment and Clinical Applications in Hypertrophic Cardiomyopathy

Myocardial stiffness is a central determinant of diastolic dysfunction and clinical outcomes in hypertrophic cardiomyopathy; however, a non-invasive evaluation of myocardial stiffness remains challenging. Emerging techniques, such as elastography, offer direct, non-invasive quantification of myocardial stiffness, providing critical insights beyond conventional indirect surrogates. This review summarizes the principles, validation, and clinical evidence for current non-invasive techniques for assessing myocardial stiffness. We further discuss the clinical applications of these techniques in hypertrophic cardiomyopathy, including diagnostic refinement, fibrosis detection, risk stratification, and treatment monitoring, as well as the challenges and future directions required for broader clinical translation. Ultimately, the non-invasive assessment of myocardial stiffness holds promise for transforming patient management to phenotyping and therapeutic decision-making through a more precise, mechanism-based approach.