Photo Credit: Ilya Lukichev
A recent study validated new thresholds for left ventricular hypertrophy to improve both HCM diagnosis and timely treatment of HCM.
A diagnosis of hypertrophic cardiomyopathy (HCM) traditionally focuses on identifying left ventricular hypertrophy (LVH) with a maximum wall thickness of ≥ 15 mm, which is established as the fixed threshold.
Given that patients vary widely in age, weight, and height, Hunain Shiwani, MD, and colleagues developed a study to examine a diagnosis method incorporating individualized patient demographics when considering LVH thresholds. The study’s findings were published in the Journal of the American College of Cardiology published the study’s findings.
Dr. Shiwani spoke with Physician’s Weekly (PW) about the information uncovered in this work.
PW: Why did this topic need exploration?
Dr. Shiwani: Medicine often holds onto historical standards long after technology has evolved to challenge them. The 15mm threshold for diagnosing HCM was established in 1973 using M-mode echocardiography and just 79 control patients. Today, with access to large-scale datasets and AI capabilities, we can finally re-examine these decades-old assumptions.
Our study analyzed more than 50,000 cardiac MRIs using AI to make precise measurements at a scale never before possible. This allowed us to redefine what’s truly ‘normal’ for each patient.
What are the most important findings from your research?
Our findings challenge the one-size-fits-all approach to cardiac diagnosis. We know that “normal” varies significantly based on who you are. A measurement that would be concerning in a small-framed young woman might be perfectly normal for a tall, older man.
Perhaps most striking was discovering that women with HCM, despite having thinner heart walls than men with the disease, had more severe relative hypertrophy when properly adjusted for body size. This helps explain why women often present later with more advanced disease—we’ve been using criteria that systematically delay their diagnosis.
How can these findings be incorporated into practice?
Although the tools and data needed to generate this were complex, we’ve developed straightforward reference tables that clinicians can use to determine the appropriate threshold for their specific patient quickly. This is similar to how we use growth charts in pediatrics—we’re just bringing that personalized approach to adult patients with HCM. This isn’t about making diagnosis more complicated; it’s about making it more accurate.
What makes this issue urgent?
We’re entering an era of precision medicine, and for the first time, new targeted therapies are being developed specifically for HCM. However, these treatments can only help properly diagnosed patients. Our current approach misses patients who need treatment while potentially overdiagnosing others who don’t. With further therapies on the horizon, accurate diagnosis becomes even more critical.
Do you have recommendations for future research directions?
The application of AI and big data analytics is just beginning to transform cardiology. We must expand this approach to diverse populations and integrate it with other emerging technologies. Imagine combining demographic-adjusted measurements with genetic data, advanced imaging features, and clinical characteristics to create personalized diagnostic and treatment pathways. The computing power and datasets now available make this possible in ways we couldn’t have dreamed of even a decade ago.
Is there anything else you would like to share?
What’s most exciting about this research is that it represents a broader shift in medicine. We’re moving from standards based on small studies from decades ago to dynamic, data-driven approaches that can continuously improve as we gather more information. This study focused on heart wall thickness, but the same principles could apply to countless other medical measurements and diagnostic criteria.
We’re witnessing the beginning of a revolution in how we define normal in medicine.