Hypertrophic Cardiomyopathy: Evolution to the Present, Ongoing Challenges, and Opportunities

The authors of this editorial have been privileged to facilitate this focus issue of the Canadian Journal of Cardiology on hypertrophic cardiomyopathy (HCM). The articles address topical issues and controversies, particularly related to the management of HCM. The familial and genetic basis, the importance of multidisciplinary clinical teams with genetic, imaging, and speci fi c disease expertise are highlighted. Controversies related to the optimal management of left ventricular out fl ow tract (LVOT) obstruction are presented from the perspective of pharmacological, percutaneous, and surgical treatment with the predictable biases of the medical, interventional, and surgical expert author teams. Speci fi c articles highlight important differences in the diagnosis and management of HCM in the pediatric population, the recognition and treatment of HCM in association with systemic disease (eg, the RASopathies), and the common and challenging issues related to the determinants and management of atrial fi brillation. There is a strong emphasis on the future related to issues such as the management of HCM in athletes and the use of induced pluripotent stem cells to better understand disease development. Innovations in cardiac imaging, which provide tissue characterization of HCM and in fl uence management of the condition, are also reviewed. These novel approaches aim to facilitate improved pharmacological (targeted treatment) and genetically -based treatments (eg, myosin inhibitors, gene therapy). Aspects related to the diagnosis of HCM and risk strati fi cation to identify patients at risk of sudden death are not presented in speci fi c articles but are discussed brie fl y in this editorial.