EJHF expert consensus statement on the diagnosis and management of hypertrophic cardiomyopathy

Hypertrophic cardiomyopathy (HCM) is the most prevalent genetic cardiac disease and a leading cause of heart failure, arrhythmia, and sudden cardiac death in both young and older adults. This consensus document was developed by a multidisciplinary panel of European and U.S. experts in HCM, imaging, electrophysiology, genetics, and heart failure. While it aligns with the 2023 ESC and 2024 AHA/ACC guidelines on HCM, the paper addresses areas where clinicians might require further guidance. Key sections include phenotypic classification, diagnostic strategies incorporating multimodal imaging and genetic testing, and risk stratification for sudden cardiac death. The document outlines therapeutic pathways for pharmacologic treatment, including beta-blockers, calcium channel blockers, disopyramide, and cardiac myosin inhibitors such as mavacamten and aficamten, as well as indications for septal reduction therapies. Management of atrial fibrillation, hypertension, coronary artery disease, pregnancy, paediatric HCM, and comorbidities is discussed in detail. Importantly, the consensus addresses current controversies including optimal risk stratification models, the care of genotype-positive/phenotype-negative individuals, and exercise recommendations. Finally, the manuscript highlights future directions such as gene therapy, precision medicine approaches, use of artificial intelligence and novel biomarkers for screening and diagnosis.