Hypertrophic Cardiomyopathy Today: Integrating Myosin Inhibition with Established Strategies

Objective: The aim of this study is to provide an up-to-date synthesis of hypertrophic cardiomyopathy (HCM), integrating progress in imaging, genetics, and therapeutics (especially cardiac myosin inhibitors) while emphasizing individualized care for obstructive and nonobstructive disease. Methods: This narrative review discusses contemporary literature on HCM, including epidemiology, mechanisms, diagnostic tools, and management. Particular emphasis is placed on multimodality imaging (echocardiography and cardiac magnetic resonance), risk stratification methods, and trial evidence for mavacamten and aficamten. Results: Over the past two decades, earlier diagnosis and better risk assessment have helped reduce HCM-related mortality. In obstructive HCM, cardiac myosin inhibitors have shown consistent benefits on symptoms, LV outflow tract gradients, and functional capacity. By contrast, nonobstructive HCM remains harder to treat, and some patients progress to advanced heart failure. Biomarkers, strain parameters, and CMR fibrosis quantification may support longitudinal monitoring. Discussion: Myosin inhibition has changed the therapeutic landscape for obstructive HCM and may extend beyond symptom relief, but long-term safety and broader applicability remain unclear. The expanding use of advanced imaging and biomarkers is key to individualized decision-making and risk assessment. Conclusion: HCM is not static; with careful follow-up and multidisciplinary care, outcomes are increasingly favorable. Integrating newer biologic therapies with established management remains a priority, while access and unmet needs (particularly in non-obstructive HCM) still require attention.