LGE Means Better Selection of HCM Patients for Primary Prevention Implantable Defibrillators ∗

S ince the first reports of hypertrophic cardiomyopathy (HCM) more than 55 years ago, sudden death has been the most highly visible and feared complication of this complex and heterogeneous genetic heart disease (1–4). Over this time, by virtue of numerous retrospective and observational cohort studies, a risk stratification algorithm has emerged in HCM (1–3) that has been effective in identifying many high-risk patients (Figure 1). Indeed, the assembly of reliable risk markers has now become a critical clinical tool given the availability of the implantable cardioverter-defibrillator (ICD) to the HCM patient population over the past 15 years (5,6), making primary prevention of sudden death a reality in this disease.