Cardiac magnetic resonance research advances in myocardial fibrosis of hypertrophic cardiomyopathy.

Hypertrophic cardiomyopathy (HCM) is a common inherited myocardial disorder characterized by left ventricular wall thickening, cardiomyocyte disarray, and varying degrees of interstitial and replacement fibrosis. Myocardial fibrosis plays a central role in the pathological progression of HCM, directly contributing to ventricular remodeling, diastolic dysfunction, and electrical instability and serving as a key mediator of adverse clinical outcomes such as arrhythmias, heart failure, and sudden cardiac death. In recent years, cardiac magnetic resonance imaging (CMR) has been widely adopted for the non-invasive detection and quantification of myocardial fibrosis in patients with HCM due to its high spatial resolution, multiparametric assessment capabilities, and excellent tissue specificity, demonstrating significant value in structural evaluation, risk stratification, and clinical decision-making. This review systematically summarizes the key research advances in recent years regarding the assessment of myocardial fibrosis in HCM using CMR, with a particular focus on the clinical applications and research frontiers of multiparametric imaging techniques such as late gadolinium enhancement (LGE), T1 mapping, and extracellular volume fraction (ECV) in fibrosis quantification, microstructural identification, and prognostic evaluation. Additionally, it explores the current challenges in imaging standardization, parameter stability, and multicenter validation, while also envisioning future development trends involving integration with artificial intelligence, multimodal imaging, and molecular biology in patients with HCM. The aim is to provide systematic academic references for mechanistic research and personalized management of HCM fibrosis.