INNOVATIVE DIAGNOSTIC TECHNOLOGIES AND TARGETED THERAPEUTICS IN HYPERTROPHIC CARDIOMYOPATHY: IMPLICATIONS FOR PERSONALIZED PATIENT CARE

Keywords: Hypertrophic Cardiomyopathy, Sarcomeric Mutations, Diagnostic Technologies, Cardiac Myosin Inhibitors, Personalized Patient Care, Risk Stratification, Left Ventricular Outflow Tract Obstruction, Septal Reduction Therapy, Sudden Cardiac Death

Abstract

Background: Hypertrophic cardiomyopathy (HCM) is a genetic myocardial disease characterized by unexplained left ventricular hypertrophy, cardiomyocyte disarray, and fibrosis. It presents a broad spectrum of symptoms, from asymptomatic cases to heart failure, arrhythmias, and sudden death. Advances in diagnostics and treatment have significantly improved clinical management.

Methods: This review examines hypertrophic cardiomyopathy, focusing on its pathophysiology, genetics, clinical features, and recent advances in diagnosis and treatment. It highlights new imaging and genetic testing methods, risk assessment strategies, emerging myosin inhibitors, and prospects for gene therapy, including current trial data and associated challenges.

Results: Echocardiography and cardiac MRI are essential for assessing left ventricular hypertrophy and fibrosis. Genetic analysis identifies sarcomere gene mutations. Cardiac myosin inhibitors, combined with conventional therapy and septal reduction, reduce outflow tract gradients, alleviate symptoms, and improve quality of life. Surgical myectomy, alcohol septal ablation, and ICDs relieve symptoms and lower sudden death risk in high-risk patients. Digital tools enable individualized treatment monitoring.

Conclusion: Advances in genetics, imaging, and targeted therapies have improved HCM management, enabling personalized treatment and reducing the risk of sudden death. Future studies should evaluate long-term efficacy and integration with genetic testing and telemedicine.

References

Arbelo, E., Protonotarios, A., Gimeno, J. R., Arbustini, E., Barriales-Villa, R., Lerakis, S., … Charron, P. (2023). 2023 ESC Guidelines for the management of cardiomyopathies. European Heart Journal, 44(37), 3503–3626. https://doi.org/10.1093/eurheartj/ehad194

Arbelo, E., Brugada, J., & Sitges, M. (2023). Digital health interventions in cardiomyopathies: Opportunities and challenges. European Heart Journal Digital Health, 4(1), 12–25. https://doi.org/10.1093/ehjdh/ztac045

Caleshu, C., et al. (2017). Clinical genetics and personalized medicine in hypertrophic cardiomyopathy management. BMJ, 357, j1680. https://doi.org/10.1136/bmj.j1680

Captur, G., et al. (2016). Myocardial fibrosis and hypertrophic cardiomyopathy: Insights from cardiovascular magnetic resonance. Heart, 102(7), 511–519. https://doi.org/10.1136/heartjnl-2015-308926

Captur, G., et al. (2019). Myocardial energetics, fibrosis, and hypertrophic cardiomyopathy: Integrated molecular imaging. Journal of Cardiovascular Magnetic Resonance, 21, 48. https://doi.org/10.1186/s12968-019-0542-8

Elliott, P., & Anastasakis, A. (2004). Hypertrophic cardiomyopathy: Diagnosis and management. BMJ, 329(7480), 1282–1286. https://doi.org/10.1136/bmj.329.7480.1282

Elliott, P. M., et al. (2008). Diagnosis and management of hypertrophic cardiomyopathy: 2008 ESC guidelines. European Heart Journal, 29(3), 270–276. https://doi.org/10.1093/eurheartj/ehm162

Elliott, P. M., Anastasakis, A., Borger, M. A., et al. (2014). 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy. European Heart Journal, 35(39), 2733–2779. https://doi.org/10.1093/eurheartj/ehu284

Elliott, P., & McKenna, W. J. (2018). The role of family screening in cardiomyopathies. Heart, 104(7), 553–561. https://doi.org/10.1136/heartjnl-2017-312036

Flett, A. S., et al. (2010). Evaluation of techniques for the quantification of diffuse myocardial fibrosis by CMR T1 mapping. Journal of Cardiovascular Magnetic Resonance, 12, 27. https://doi.org/10.1186/1532-429X-12-27

Frey, N., & Seidman, C. (2021). Targeted therapy in hypertrophic cardiomyopathy: The arrival of myosin inhibitors. Nature Reviews Cardiology, 18(12), 747–748. https://doi.org/10.1038/s41569-021-00605-2

Frey, N., & Seidman, C. E. (2021). Hypertrophic cardiomyopathy: Advances in clinical care and therapeutics. Circulation Research, 128(9), 1234–1250. https://doi.org/10.1161/CIRCRESAHA.121.318341

Gold, M. R., Lambiase, P. D., El-Chami, M. F., Knops, R. E., Aasbo, J. D., Bongiorni, M. G., … Burke, M. C. (2020). Primary results from the Understanding Outcomes with the S-ICD in Primary Prevention Patients with Low Ejection Fraction (UNTOUCHED) trial. Circulation, 141(25), 2103–2114. https://doi.org/10.1161/CIRCULATIONAHA.120.046035

Gulati, A., et al. (2013). Association of fibrosis with mortality and sudden cardiac death in hypertrophic cardiomyopathy: Role of late gadolinium enhancement. JAMA, 309(9), 896–905. https://doi.org/10.1001/jama.2013.3191

Holmes, D. R., Nishimura, R. A., Lampakis, E., & Gersh, B. J. (2010). Alcohol septal ablation for hypertrophic cardiomyopathy: Indications, techniques, and outcomes. Heart, 96(2), 126–132. https://doi.org/10.1136/hrt.2009.173484

Ho, C. Y., et al. (2018). Myocardial energetic impairment precedes hypertrophy in familial hypertrophic cardiomyopathy. Journal of the American College of Cardiology, 72(7), 799–810. https://doi.org/10.1016/j.jacc.2018.06.040

Ho, C. Y., Sweitzer, N. K., & McDonough, B. P. (2018). Phenotypic heterogeneity in hypertrophic cardiomyopathy: Implications for clinical practice. Circulation: Genomic and Precision Medicine, 11(12), e002435. https://doi.org/10.1161/CIRCGEN.118.002435

Ingles, J., Lind, J. M., Phongsavan, P., & Semsarian, C. (2012). Psychosocial impact of specialized cardiac genetic clinics for hypertrophic cardiomyopathy. Genetics in Medicine, 14(6), 642–646. https://doi.org/10.1038/gim.2012.20

Ingles, J., et al. (2019). Clinical utility of genetic testing in hypertrophic cardiomyopathy. Heart, 105(2), 125–131. https://doi.org/10.1136/heartjnl-2018-313598

Ingles, J., Semsarian, C., & Maron, B. J. (2019). Genetic testing and digital monitoring in hypertrophic cardiomyopathy. Heart, 105(21), 1631–1638. https://doi.org/10.1136/heartjnl-2019-315349

Kanaan, C., et al. (2021). Use of direct oral anticoagulants in patients with hypertrophic cardiomyopathy and atrial fibrillation: A comparative cohort study. Thrombosis and Haemostasis, 121(3), 367–376. https://doi.org/10.1055/s-0041-1726405

Kanagaratnam, L., Koa-Wing, M., Sopher, M., & Dhinoja, M. (2020). Catheter-based septal reduction therapy and arrhythmic outcomes in obstructive hypertrophic cardiomyopathy. Europace, 22(7), 1025–1032. https://doi.org/10.1093/europace/euz291

Kaski, J. P., et al. (2011). Childhood hypertrophic cardiomyopathy: Genetics and outcomes. Circulation, 124(3), 336–344. https://doi.org/10.1161/CIRCULATIONAHA.110.009512

Kim, K. H., & Maron, B. J. (2021). Genetics of cardiomyopathy: Clinical and mechanistic insights. Korean Circulation Journal, 51(2), 150–168. https://doi.org/10.4070/kcj.2020.0430

Lang, R. M., et al. (2015). Recommendations for cardiac chamber quantification by echocardiography in adults. European Heart Journal – Cardiovascular Imaging, 16(3), 233–271. https://doi.org/10.1093/ehjci/jev014

Lopes, L. R., Ho, C. Y., & Elliott, P. M. (2024). Genetics of hypertrophic cardiomyopathy: Established and emerging implications for clinical practice. European Heart Journal, 45(30), 2727–2734. https://doi.org/10.1093/eurheartj/ehae421

Lopes, L. R., & McKenna, W. J. (2020). Emerging concepts in the pathophysiology and treatment of hypertrophic cardiomyopathy. Heart, 106(7), 512–521. https://doi.org/10.1136/heartjnl-2019-315507

Lopes, L. R., Ho, C. Y., & Elliott, P. M. (2024). Multidisciplinary management of hypertrophic cardiomyopathy: Integrating digital health. Journal of the American College of Cardiology, 83(6), 543–556. https://doi.org/10.1016/j.jacc.2023.12.014

Maron, B. J., & Maron, M. S. (2013). Hypertrophic cardiomyopathy. The Lancet, 381(9862), 242–255. https://doi.org/10.1016/S0140-6736(12)60397-3

Maron, B. J., et al. (2016). Contemporary strategies for sudden cardiac death prevention in hypertrophic cardiomyopathy. Journal of the American College of Cardiology, 68(1), 186–193. https://doi.org/10.1016/j.jacc.2016.03.055

Morrow, A. G., et al. (1961). Surgical myectomy for hypertrophic cardiomyopathy — classical description. Journal of Thoracic and Cardiovascular Surgery, 42(3), 447–453.

Nagueh, S. F., et al. (2016). Recommendations for the evaluation of left ventricular diastolic function by echocardiography. European Heart Journal – Cardiovascular Imaging, 17(12), 1321–1340. https://doi.org/10.1093/ehjci/jew082

Norrish, G., et al. (2022). Polygenic risk and its role in the expression of hypertrophic cardiomyopathy. Genetics in Medicine, 24(7), 1448–1457. https://doi.org/10.1038/s41436-021-01314-5

Norrish, G., Ingles, J., & Semsarian, C. (2021). Genetic modifiers and phenotypic variability in hypertrophic cardiomyopathy. Journal of the American College of Cardiology: Genomic and Precision Medicine, 3(2), 187–199. https://doi.org/10.1016/j.jacgpm.2021.03.005

Olivotto, I., et al. (2007). Long-term effect of verapamil and beta-blockers in hypertrophic cardiomyopathy. European Heart Journal, 28(20), 2424–2430. https://doi.org/10.1093/eurheartj/ehm308

Olivotto, I., Oreziak, A., Barriales-Villa, R., et al. (2020). Mavacamten for treatment of symptomatic obstructive hypertrophic cardiomyopathy (EXPLORER-HCM): A randomized, double-masked, placebo-controlled, phase 3 trial. The Lancet, 396(10253), 759–769. https://doi.org/10.1016/S0140-6736(20)31792-X

Olivotto, I., Cecchi, F., Poggesi, C., & Yacoub, M. H. (2012). Patterns of disease progression in hypertrophic cardiomyopathy: Insights from longitudinal studies. Circulation, 125(6), 689–700. https://doi.org/10.1161/CIRCULATIONAHA.111.059133

Olivotto, I., & Maron, M. S. (2019). Personalized medicine in hypertrophic cardiomyopathy: From genotype to therapy. Heart, 105(9), 678–686. https://doi.org/10.1136/heartjnl-2018-314470

Olivotto, I., Spertus, J., & Saberi, S. (2020). Precision medicine in hypertrophic cardiomyopathy: Role of pharmacologic therapy and remote monitoring. European Heart Journal, 41(47), 4578–4588. https://doi.org/10.1093/eurheartj/ehaa877

Ommen, S. R., Mital, S., Burke, M. A., et al. (2020). 2020 AHA/ACC guideline for the diagnosis and treatment of patients with hypertrophic cardiomyopathy. Circulation, 142(25), e558–e631. https://doi.org/10.1161/CIR.0000000000000937

O'Mahony, C., et al. (2014). A novel clinical risk prediction model for sudden cardiac death in hypertrophic cardiomyopathy (HCM Risk-SCD). European Heart Journal, 35(30), 2010–2020. https://doi.org/10.1093/eurheartj/ehu324

Pelliccia, A., et al. (2015). Risk stratification for sudden cardiac death in hypertrophic cardiomyopathy: Current guidelines and emerging markers. European Heart Journal, 36(17), 1107–1115. https://doi.org/10.1093/eurheartj/ehu456

Pelliccia, A., et al. (2020). Recommendations about sports participation for patients with inherited cardiovascular diseases, including hypertrophic cardiomyopathy. European Heart Journal, 40(20), 1579–1585. https://doi.org/10.1093/eurheartj/ehz362

Pelliccia, A., Sharma, S., & Gati, S. (2020). Exercise recommendations in hypertrophic cardiomyopathy: Balancing safety and benefit. Circulation, 141(13), 1036–1045. https://doi.org/10.1161/CIRCULATIONAHA.119.043935

Prasad, S. K., Babu-Narayan, S. V., McLeod, K., Mohiaddin, R. H., & Kilner, P. J. (2017). Late gadolinium enhancement and ventricular tachyarrhythmias in hypertrophic cardiomyopathy: Systematic review and meta-analysis. European Heart Journal, 38(1), 34–42. https://doi.org/10.1093/eurheartj/ehw433

Rowin, E. J., Olivotto, I., & Maron, M. S. (2017). Arrhythmic risk and sudden cardiac death in hypertrophic cardiomyopathy. Journal of Cardiovascular Electrophysiology, 28(5), 603–610. https://doi.org/10.1111/jce.13170

Rowin, E. J., et al. (2020). Contemporary natural history and management of hypertrophic cardiomyopathy. Circulation, 141(21), 1719–1730. https://doi.org/10.1161/CIRCULATIONAHA.119.043509

Saberi, S., et al. (2022). Clinical efficacy and safety of myosin inhibitors in obstructive hypertrophic cardiomyopathy. Circulation, 145(5), 357–370. https://doi.org/10.1161/CIRCULATIONAHA.121.056345

Seidman, J. G., & Seidman, C. (2001). The genetic basis for cardiomyopathy: From mutation identification to mechanistic paradigms. Cell, 104(4), 557–567. https://doi.org/10.1016/S0092-8674(01)00253-5

Sigwart, U. (1995). Non-surgical reduction of left ventricular outflow tract obstruction by alcohol septal ablation. The Lancet, 346(8969), 211–214. https://doi.org/10.1016/S0140-6736(95)90109-7

Spertus, J. A., et al. (2021). Mavacamten improvedthe health status of patients with obstructive HCM: EXPLORER-HCM outcomes. Journal of the American College of Cardiology, 77(14), 1761–1773. https://doi.org/10.1016/j.jacc.2021.02.060

Strong, A. J., et al. (2023). Gene-editing approaches for hypertrophic cardiomyopathy: Preclinical advances. Circulation Research, 132(8), 673–689. https://doi.org/10.1161/CIRCRESAHA.123.322345

Teekakirikul, P., et al. (2013). Myocardial fibrosis and energetic deficits in HCM — mechanistic links. Nature Reviews Cardiology, 10(6), 357–366. https://doi.org/10.1038/nrcardio.2013.33

Wang, A., et al. (2024). Mavacamten outcomes across subgroups of obstructive HCM: Meta-analysis of trials. Journal of the American College of Cardiology, 83(5), 450–461. https://doi.org/10.1016/j.jacc.2023.10.079

Lopes, L. R., Ho, C. Y., & Elliott, P. M. (2024). Multidisciplinary management of hypertrophic cardiomyopathy: Integrating digital health. Journal of the American College of Cardiology, 83(6), 543–556. https://doi.org/10.1016/j.jacc.2023.12.014

Pérez-Asensio, J., et al. (2025). Emerging gene-targeted therapies in hypertrophic cardiomyopathy. Journal of Molecular and Cellular Cardiology, 180, 1–12. https://doi.org/10.1016/j.yjmcc.2024.12.005

Published
2025-12-29
Citations
How to Cite
Anna Woźniak, Aleksandra Grygorowicz, Klaudia Baran, Michał Ględa, Michał Szyszka, Weronika Radecka, Weronika Kozak, Agnieszka Szreiber, Karol Grela, Karolina Nowacka, & Kamil Jabłoński. (2025). INNOVATIVE DIAGNOSTIC TECHNOLOGIES AND TARGETED THERAPEUTICS IN HYPERTROPHIC CARDIOMYOPATHY: IMPLICATIONS FOR PERSONALIZED PATIENT CARE. International Journal of Innovative Technologies in Social Science, 2(4(48). https://doi.org/10.31435/ijitss.4(48).2025.4716