MINI REVIEW article
Front. Cardiovasc. Med.
Sec. Cardiovascular Imaging
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1649728
This article is part of the Research TopicDisparities, controversies and unmet needs in the management of cardiomyopathiesView all 5 articles
Imaging Myocardial Scar in Hypertrophic Cardiomyopathy: advances in CMR and CT
Provisionally accepted
Matteo Sclafani1,2
Chiara Perrotti2Luigi Salerno2Melwyn Luis Muthukkattil2Camilla Lustri2Gabriele Cristofari2
Giulio Falasconi3
Beatrice Musumeci2Diego Penela3,4
Andrea Saglietto5
Agnese Iannaccone6Emanuele Barbato2Antonio Berruezo3
Pietro Francia2*- 1Royal Brompton Hospital, London, United Kingdom
- 2Cardiology Unit, Department of Clinical and Molecular Medicine, Sant’Andrea University Hospital, Sapienza University, Rome, Italy, Rome, Italy
- 3Centro Medico Teknon, Barcelona, Spain
- 4IRCCS Humanitas Research Hospital, Rozzano, Italy
- 5Azienda Ospedaliero Universitaria Citta della Salute e della Scienza di Torino Cardiologia U, Turin, Italy
- 6Universita degli Studi di Bologna Dipartimento di Scienze Statistiche Paolo Fortunati, Bologna, Italy
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Myocardial scarring is a hallmark of hypertrophic cardiomyopathy (HCM) and a major driver of adverse outcomes, including sudden cardiac death and heart failure progression. The fibrotic substrate in HCM is complex, encompassing both replacement and interstitial fibrosis, often accompanied by myocardial disarray. Advanced cardiovascular imaging enables detailed scar characterization, which is crucial for risk stratification and personalized management. Cardiovascular magnetic resonance (CMR) is the gold standard for non-invasive fibrosis assessment. Techniques such as late gadolinium enhancement, myocardial mapping of T1 and T2 relaxation properties, and diffusion tensor imaging provide complementary insights into scar burden and architecture. Cardiac computed tomography (CT) is an emerging modality with increasing clinical relevance. Delayed iodine enhancement and CT-derived extracellular volume mapping offer a valuable alternative for scar assessment, particularly when CMR is contraindicated. This review highlights the role of multimodality imaging in assessing myocardial scar in HCM, with a focus on CMR and CT, and explores their clinical implications.
Keywords: Hypertrophic Cardiomyopathy, HCM, Cardiovascular magnetic resonance, CMR, Cardiac computed tomography, CT, Myocardial scar, late gadolinium enhancement
Received: 18 Jun 2025; Accepted: 02 Sep 2025.
Copyright: © 2025 Sclafani, Perrotti, Salerno, Muthukkattil, Lustri, Cristofari, Falasconi, Musumeci, Penela, Saglietto, Iannaccone, Barbato, Berruezo and Francia. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Pietro Francia, Cardiology Unit, Department of Clinical and Molecular Medicine, Sant’Andrea University Hospital, Sapienza University, Rome, Italy, Rome, Italy
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