Demographic-Based Personalized Left Ventricular Hypertrophy Thresholds for Hypertrophic Cardiomyopathy Diagnosis.

Summary

Using AI-derived CMR measurements across >50,000 individuals, the authors show that age-, sex-, and BSA-adjusted LVH thresholds (10–17 mm) substantially reduce misclassification and sex/body-size bias compared with the fixed 15-mm rule. Personalized z-scores improved HCM ascertainment, especially in women who often have lower absolute MWT but higher standardized burden.

Key Findings

• Demographically adjusted LVH thresholds (10–17 mm) halved LVH ascertainment in the population cohort (4.3% to 2.2%) and reduced male skew from 89% to 56%.
• In the HCM cohort, a substantial fraction diagnosed with MWT <15 mm dropped from 27% to 7% (women) and 18% to 15% (men) using adjusted thresholds.
• Women showed lower absolute MWT but higher MWT z-scores, highlighting the need for standardized, personalized diagnostic metrics.

Clinical Implications

Adopting demographically adjusted LVH thresholds and z-scores can reduce underdiagnosis in women and smaller-bodied individuals, refine referral for genetic testing, and better target surveillance in suspected HCM.

Limitations

• Observational design without interventional validation of clinical outcomes using adjusted thresholds.
• Generalizability to non-CMR modalities (e.g., echocardiography) requires further study.

Future Directions

Prospective clinical trials should test whether adjusted thresholds improve outcomes, refine echocardiographic translation, and support guideline updates for HCM diagnosis.