{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T11:05:37Z","timestamp":1784027137612,"version":"3.55.0"},"reference-count":201,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T00:00:00Z","timestamp":1783987200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medical Sciences"],"abstract":"<jats:p>Hypertrophic cardiomyopathy (HCM) is a common inherited myocardial disorder and a leading cause of sudden cardiac death (SCD) across all age groups. Accurate risk stratification remains a clinical challenge, as conventional algorithms fail to fully capture the heterogeneous arrhythmic substrate of the disease. In recent years, cardiac imaging has emerged as a pivotal tool for refining SCD prediction by providing detailed structural, functional, and tissue-characterisation data. This review offers a comprehensive synthesis of imaging-derived predictors of SCD in HCM. We examine established echocardiographic markers, including maximal left ventricular wall thickness, left ventricular ejection fraction and left ventricular outflow tract obstruction, together with advanced cardiovascular magnetic resonance parameters such as late gadolinium enhancement and apical aneurysm detection. In addition, we discuss the emerging role of extracellular volume expansion, quantitative mapping techniques, and strain abnormalities within the framework of contemporary risk stratification models. By bridging imaging biomarkers with underlying pathophysiological mechanisms, this review highlights current evidence, limitations, and future directions to improve precision in SCD risk assessment in HCM.<\/jats:p>","DOI":"10.3390\/medsci14030390","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T10:12:53Z","timestamp":1784023973000},"page":"390","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Imaging-Based Risk Stratification for Sudden Cardiac Death in Hypertrophic Cardiomyopathy: Current Evidence and Clinical Perspectives"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-1513-2424","authenticated-orcid":false,"given":"\u00c8lia","family":"Rif\u00e9-Pardo","sequence":"first","affiliation":[{"name":"Department of Cardiology, Hospital Universitari Vall d\u2019Hebron, 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-4110-3725","authenticated-orcid":false,"given":"Sara","family":"S\u00f3\u00f1ora-L\u00f3pez","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital Universitari Vall d\u2019Hebron, 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7122-320X","authenticated-orcid":false,"given":"Guillem","family":"Casas","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital Universitari Vall d\u2019Hebron, 08035 Barcelona, Spain"},{"name":"Cardiovascular Imaging Unit and Inherited Cardiovascular Diseases Unit, Cardiology Department, Vall d\u2019Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d\u2019Hebron, 08035 Barcelona, Spain"},{"name":"Biomedical Research Networking Centre on Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Soledad","family":"Ceballos","sequence":"additional","affiliation":[{"name":"Cardiovascular Imaging Unit and Inherited Cardiovascular Diseases Unit, Cardiology Department, Vall d\u2019Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d\u2019Hebron, 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-9335-7791","authenticated-orcid":false,"given":"Leandro Santiago","family":"Videla","sequence":"additional","affiliation":[{"name":"Cardiovascular Imaging Unit and Inherited Cardiovascular Diseases Unit, Cardiology Department, Vall d\u2019Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d\u2019Hebron, 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3644-9494","authenticated-orcid":false,"given":"Javier","family":"Limeres-Freire","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital Universitari Vall d\u2019Hebron, 08035 Barcelona, Spain"},{"name":"Cardiovascular Imaging Unit and Inherited Cardiovascular Diseases Unit, Cardiology Department, Vall d\u2019Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d\u2019Hebron, 08035 Barcelona, Spain"},{"name":"Biomedical Research Networking Centre on Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain"},{"name":"Cardiovascular Diseases, Vall d\u2019Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d\u2019Hebron, 08035 Barcelona, Spain"},{"name":"Department of Medicine, Universitat Aut\u00f2noma de Barcelona, 08023 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4714-2420","authenticated-orcid":false,"given":"Gisela","family":"Teixid\u00f3-Tura","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital Universitari Vall d\u2019Hebron, 08035 Barcelona, Spain"},{"name":"Cardiovascular Imaging Unit and Inherited Cardiovascular Diseases Unit, Cardiology Department, Vall d\u2019Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d\u2019Hebron, 08035 Barcelona, Spain"},{"name":"Biomedical Research Networking Centre on Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain"},{"name":"Cardiovascular Diseases, Vall d\u2019Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d\u2019Hebron, 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ignacio","family":"Ferreira-Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital Universitari Vall d\u2019Hebron, 08035 Barcelona, Spain"},{"name":"Cardiovascular Diseases, Vall d\u2019Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d\u2019Hebron, 08035 Barcelona, Spain"},{"name":"Department of Medicine, Universitat Aut\u00f2noma de Barcelona, 08023 Barcelona, Spain"},{"name":"Epidemiology and Public Health Networking Biomedical Research Centre (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7229-9780","authenticated-orcid":false,"given":"Jos\u00e9 F.","family":"Rodr\u00edguez-Palomares","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital Universitari Vall d\u2019Hebron, 08035 Barcelona, Spain"},{"name":"Cardiovascular Imaging Unit and Inherited Cardiovascular Diseases Unit, Cardiology Department, Vall d\u2019Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d\u2019Hebron, 08035 Barcelona, Spain"},{"name":"Biomedical Research Networking Centre on Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain"},{"name":"Cardiovascular Diseases, Vall d\u2019Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d\u2019Hebron, 08035 Barcelona, Spain"},{"name":"Department of Medicine, Universitat Aut\u00f2noma de Barcelona, 08023 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3503","DOI":"10.1093\/eurheartj\/ehad194","article-title":"2023 ESC Guidelines for the management of cardiomyopathies: Developed by the task force on the management of cardiomyopathies of the European Society of Cardiology (ESC)","volume":"44","author":"Arbelo","year":"2023","journal-title":"Eur. 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