ABC | Volume 112, Nº3, March 2019

Short Editorial Sara-da-Silva Myocardial fibrosis in hypertrophic cardiomyopathy Arq Bras Cardiol. 2019; 112(3):290-291 1. Maron BJ. Clinical Course and Management of Hypertrophic Cardiomyopathy. N Engl J Med. 2018;379(7):655–68. 2. Maron BJ, Maron MS, Rowin EJ. Perspectives on the Overall Risks of Living with Hypertrophic Cardiomyopathy. Circulation. 2017;135:2317-9. 3. Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer MA, Link MS, et al. 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy:AreportoftheAmericanCollegeofCardiologyFoundation/ AmericanHeart Association Task Force on Practice Guidelines Developed in CollaborationwiththeAmericanAss.JAmCollCardiol.2011;58(25):212–60. 4. Zamorano JL, Anastasakis A, Borger MA, Borggrefe M, Cecchi F, Charron P, et al. 2014 ESC guidelines on diagnosis and management of hypertrophic cardiomyopathy: The task force for the diagnosis and management of hypertrophic cardiomyopathy of the European Society of Cardiology (ESC). Vol. 35, European Heart Journal. 2014. p. 2733–79. 5. Sen-ChowdhryS, JacobyD,Moon JC,McKennaWJ.Updateonhypertrophic cardiomyopathy and a guide to the guidelines. Nat Rev Cardiol. 2016;13(11):651–75. 6. Moon JCC, McKenna WJ, McCrohon JA, Elliott PM, Smith GC, Pennell DJ. Toward clinical risk assessment in hypertrophic cardiomyopathy with gadolinium cardiovascular magnetic resonance. J Am Coll Cardiol. 2003;41(9):1561–7. 7. Choudhury L, Mahrholdt H,Wagner A, Choi KM, Elliott MD, Klocke FJ, et al. Myocardial scarring in asymptomatic or mildly symptomatic patients with hypertrophic cardiomyopathy. J Am Coll Cardiol.2002;40(12):2156–64. 8. Quarta G, Aquaro GD, Pedrotti P, Pontone G, Dellegrottaglie S, Iacovoni A, et al. Cardiovascular magnetic resonance imaging in hypertrophic cardiomyopathy: The importance of clinical context. Eur Heart J Cardiovasc Imaging. 2018;19:601-10. 9. Bittencourt MI, Cader SA, Araújo DV, Salles ALF, Albuquerque FN, Spineti PPM, et al. Papel da fibrose miocárdica na cardiomiopatia hipertrófica: Revisão sistemática e metanálise atualizada de marcadores de risco para morte súbita. Arq Bras Cardiol. 2019;112(3):281-289. 10. Reddy ST, Tito A, Filho P, Silva NJ, Doyle M, Yamrozik J, et al. A Systematic reviewforsuddencardiacdeath inhyoetrophiccardiomyopathypatientswith myocardial fibrosi:aCMRLGEStudy. JAmCollCardiol.2012;59(13):E1228. 11. Chan RH, Maron BJ, Olivotto I, Pencina MJ, Assenza GE, Haas T, et al. Prognostic value of quantitative contrast-enhanced cardiovascular magnetic resonance for the evaluation of sudden death risk in patients with hypertrophic cardiomyopathy. Circulation. 2014;130(6):484–95. 12. Weng Z, Yao J, Chan RH, He J, Yang X, Zhou Y, et al. Prognostic Value of LGE-CMR in HCM: A Meta-Analysis. JACC Cardiovasc Imaging. 2016;9(12):1392–402. References This is an open-access article distributed under the terms of the Creative Commons Attribution License Moreover, there is still some controversy over whether late enhancement provides clinically relevant incremental information to traditional risk factors, mostly because of the small number of primary outcomes observed in the studies. Additionally, there are no large-scale prospective studies evaluating the late enhancement quantification incorporated into the ACC/AHA and European Cardiology Society algorithms for the prediction of SD in HCM. CMR is an extremely valuable tool in the evaluation of HCM and its application for diagnostic purposes has been very well established. Similarly, the evaluation of myocardial fibrosis by the late enhancement technique is a strong prognostic marker of the disease and will probably have a great impact as a risk stratification tool. Nevertheless, according to the main guidelines on HCM, currently the clinical use of the technique for primary prophylaxis of SD is restricted to ambiguous cases, when the ICD indication is uncertain when using the traditional algorithms. 3,4 Therefore, to take one step further and for myocardial fibrosis screening to be formally incorporated into the risk stratification routine in HCM, some gaps still need to be addressed. I think it is a matter of time! 291