Hypertrophic cardiomyopathy (HCM) is an inherited primary myocardial disease characterized by asymmetrical/symmetrical left ventricle (LV) hypertrophy, with or without LV outflow tract (LVOT) dynamic obstruction, and poor prognosis. Cardiac resynchronization therapy (CRT) has emerged as a minimally invasive tool for patients with heart failure (HF) with decreased LV ejection fraction (LVEF) and prolonged QRS duration of over 120 ms with or without left bundle branch block (LBBB). Several HCM patients are at risk of developing LBBB because of disease progression or secondary to septal myomectomy, while others might develop HF with decreased LVEF, alleged end-stage/dilated HCM, especially those with thin myofilament mutations. Several studies have shown that patients with myectomy-induced LBBB might benefit from left bundle branch pacing or CRT to relieve symptoms, improve exercise capacity, and increase LVEF. Otherwise, patients with end-stage/dilated HCM and prolonged QRS interval could gain from CRT in terms of NYHA class improvement, LV systolic performance increase and, to some degree, LV reverse remodeling. Moreover, several electrical and imaging parameters might aid proper selection and stratification of HCM patients to benefit from CRT. Nonetheless, current available data are scarce and further studies are still required to accurately clarify the view. This review reassesses the importance of CRT in patients with HCM based on current research by contrasting and contextualizing data from various published studies.

Cardiac resynchronization therapy (CRT) restores ventricular dyssynchrony, improving left ventricle (LV) systolic function, symptoms, and outcome in patients with heart failure, systolic dysfunction, and prolonged QRS interval. The left atrium (LA) plays tremendous roles in maintaining cardiac function, being often inflicted in various cardiovascular diseases. LA remodeling implies structural—dilation, functional—altered phasic functions, and strain and electrical—atrial fibrillation remodeling. Until now, several important studies have approached the relationship between LA and CRT. LA volumes can predict responsiveness to CRT, being also associated with improved outcome in these patients. LA function and strain parameters have been shown to improve after CRT, especially in those who were positive responders to it. Further studies still need to be conducted to comprehensively characterize the impact of CRT on LA phasic function and strain, and, also, in conjunction with its impact on functional mitral regurgitation and LV diastolic dysfunction. The aim of this review was to provide an overview of current available data regarding the relation between CRT and LA remodeling.

Introduction: Catheter ablation (CA) for atrial fibrillation (AF) has been proven to have the highest efficacy in maintaining sinus rhythm. Several studies have proposed different scores for predicting post-procedural success, but most have not been validated in prospective cohorts. Further research is required to determine the optimal formulae. Purpose: This study aimed to identify independent predictors of AF recurrence after CA and develop a composite score. Methods: Consecutive patients with persistent and paroxysmal AF who underwent CA were retrospectively analyzed. The independent predictors of recurrence were used to create a new predictive score. Results: The cohort included 263 patients with a follow-up of 37.6 ± 23.4 months. Persistent AF, f-waves < 0.1 mV, indexed left atrium volume, the presence of type 2 diabetes, and smaller height were independent predictors of recurrence and were used to create a new scoring model, VAT-DHF (V = Volume, AT = AF Type, D = Diabetes, H = Height, F = f waves). The ROC curve for this new score showed an AUC of 0.869, p < 0.0001, 95% CI [0.802–0.936], while those for APPLE and CHA₂DS₂-VASc showed an AUC of 0.765, 95% CI [0.637–0.893] and an AUC of 0.655, 95% CI [0.580–0.730], respectively. Patients who had a VAT-DHF score between 0 and 3.25, 3.25 and 6, and ≥6, had success rates of 95.7%, 76.3%, and 25% (p < 0.0001), respectively. Conclusions: The novel VAT-DHF score is easy to calculate and may be a useful clinical tool for identifying patients with a low, intermediate, or high risk of AF recurrence after CA.

Background: Hypertrophic cardiomyopathy (HCM) is frequently associated with preserved left ventricular ejection fraction (LVEF), yet subclinical myocardial dysfunction often escapes detection using conventional imaging. Cardiac magnetic resonance (CMR) with feature tracking (FT) enables precise assessment of myocardial deformation and mechanics. Methods: In this prospective case–control study, we evaluated 150 HCM patients and 100 age- and sex-matched healthy controls using standardized CMR protocols. Global longitudinal strain (GLS), circumferential strain (GCS), radial strain (GRS), and left ventricular (LV) torsion were quantified via FT-CMR. Myocardial fibrosis was assessed through late gadolinium enhancement (LGE), native T1 mapping, and extracellular volume (ECV). Results: HCM patients showed significantly impaired strain and torsion metrics compared with controls: GLS (−16% vs. −20%), GCS (−18% vs. −21%), GRS (29% vs. 38%), and global LV torsion (1.27°/cm vs. 1.95°/cm), all p < 0.001. These abnormalities were also observed in LGE-negative patients, suggesting early functional remodeling. Global LV torsion demonstrated the highest diagnostic performance for LGE detection (AUC = 0.995), surpassing those of GLS (0.877), native T1 (0.731), and ECV (0.657). A cut-off value of 0.7°/cm provided optimal sensitivity and specificity, and was associated with adverse prognosis in survival analysis. Conclusions: CMR-derived strain and torsion parameters detect early myocardial dysfunction in HCM beyond conventional markers. Global LV torsion, in particular, emerges as a sensitive and robust non-invasive marker with diagnostic and prognostic potential.