Left Ventricular Wall Thickness in Hypertrophic Cardiomyopathy and Cardiac Amyloidosis: A Multimodality Imaging Comparison

Hypertrophic cardiomyopathy (HCM) and cardiac amyloidosis (CA) are key differential diagnoses in patients presenting with an increase in left ventricular wall thickness. Despite advances in multimodal imaging, both conditions remain underrecognized due to overlapping morphological and clinical features that complicate diagnosis and treatment. However, their distinct pathophysiological mechanisms—myocardial hypertrophy and myofibrillar disarray in HCM versus extracellular deposition of misfolded amyloid protein in CA—have direct implications for management. Timely and accurate diagnosis is critical to optimizing patient care and preventing serious adverse outcomes, including sudden cardiac death. Epidemiological factors such as age, sex, and geographic distribution, along with specific clinical characteristics, can increase pretest probability and guide targeted diagnostic evaluation. As we enter a new era of precision medicine, this review comprehensively discusses the epidemiological, clinical, and imaging distinctions between HCM and CA to enhance diagnostic accuracy and clinician awareness to provide optimal care delivery.