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Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiovascular disorder worldwide. Since its first comprehensive description nearly six decades ago, HCM has emerged as a highly heterogeneous disease with diverse genetic background, clinical presentation and natural history. While many patients with HCM remain free of symptoms and adverse events, a significant proportion of affected individuals evolve along discrete disease pathways – most commonly leading to heart failure. A must-read editorial on this topic, by Wenzl F., Ambrosini S. and Paneni F. - published recently in the International Journal of Cardiology.