Accurate risk stratification in hypertrophic cardiomyopathy (HCM) remains critical to prevent sudden cardiac death (SCD). At the European Society of Cardiology (ESC) 2025, a multicenter international retrospective analysis evaluated whether individualized maximal wall thickness (MWT) thresholds, adjusted for age, sex, and body surface area, improve prediction of arrhythmic events in HCM patients. 

The study included 530 patients (mean age 49 ± 17 years; 44% male) who underwent cardiac magnetic resonance imaging and echocardiography. Individualized upper limits of normal (ULN) were used to calculate absolute and relative excess hypertrophy for each patient. Over a median follow-up of 50 months, 28 patients experienced primary endpoint events, including Sudden Cardiac Death (SCD), sustained ventricular tachycardia, and appropriate ICD discharges. 

Neither absolute nor relative excess hypertrophy improved predictive performance for SCD-related outcomes compared to raw MWT values. Although indexed hypertrophy measures were associated with non-sustained ventricular tachycardia on Holter, no advantage was seen for primary endpoints. These findings suggest that personalized MWT adjustments offer limited utility for HCM risk stratification.