CMR Characterization of Hypertrophic Heart Diseases

Hypertrophic heart disease comprises a heterogeneous group of myocardial disorders characterized by increased left ventricular wall thickness arising from diverse pathologic processes. Despite differing etiologies, these diseases frequently demonstrate overlapping phenotypic features, which can create significant diagnostic challenges. Accurate differentiation is clinically important, given the prognostic implications associated with each condition, and the application of disease-specific therapeutic strategies. Cardiovascular magnetic resonance (CMR) has become central to the evaluation of hypertrophic heart disease due to its high spatial resolution and unique capability for comprehensive multiparametric tissue characterization. Beyond standardized assessment of ventricular volumes, function, mass, and wall thickness, CMR provides detailed characterization of myocardial fibrosis, edema, and tissue composition through late gadolinium enhancement imaging and parametric mapping techniques, including native T1, T2, and extracellular volume mapping. This review summarizes the contemporary role of CMR in the assessment of hypertrophic heart diseases, with emphasis on imaging features that aid differential diagnosis, and clinically relevant findings that influence management and prognosis.