Left atrial remodeling trajectories in hypertrophic cardiomyopathy: Reframing prognostic assessment through a dynamic lens

Hypertrophic cardiomyopathy (HCM) is increasingly recognized as a condition involving not only the left ventricle but also the left atrium (LA). In this issue of Progress in Cardiovascular Diseases, Di Napoli et al. provide compelling evidence that longitudinal trajectories of LA remodeling offer stronger prognostic value for atrial fibrillation (AF), and sudden cardiac death (SCD) in patients with HCM than do static measurements. Using group-based trajectory modeling in a 35-year cohort, the authors identified three distinct phenotypes of LA enlargement. The most adverse phenotype was associated with a 9.3-fold increased risk of AF and a 3.6-fold increased risk of SCD. These findings support dynamic rather than static risk assessment strategies. This editorial explores the methodological and clinical implications of these insights, situating LA remodeling at the forefront of contemporary HCM management.