• Transthoracic echocardiography is the first-line technique for the assessment of anatomy in patients with HCM.
• The presence, distribution, and severity of LVH should be documented in all HCM patients using a common standardized protocol for all imaging modalities. LV wall thickness should be measured at end diastole (more accurate in short-axis views).
• The systematic assessment of intraventricular obstruction (at rest, Valsalva manouvre, standing) and of all the components of the mitral valve apparatus is mandatory.
• Exercise echo should be performed in symptomatic patients if bedside manoeuvres fail to induce LVOTO ≥50 mmHg; in asymptomatic patients, it may be considered when the presence of a LVOT gradient is relevant to lifestyle advice and decisions on medical treatment.
• CMR with LGE assessment should be performed for tissue characterization (presence, location, type, and extension of fibrosis) and anatomy (WT, mitral valve apparatus, mechanism of obstruction, MR when these are not conclusively defined on echocardiography).