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The findings indicate that standard treatment thresholds may be insufficient, and more intensive risk-factor management is warranted in HCMG- patients, and that standard treatment thresholds may be insufficient.
Relatives with gene-elusive HCM identified through family screening exhibit a predominantly mild structural phenotype, lower arrhythmic burden, and few adverse outcomes compared with probands, which suggests a significant contribution to disease expression in this subgroup.
Screening yield is driven by uptake levels and existing family history, supporting systematic phenotypic screening even when no causative genetic variant is detected, and clinical cascade screening identifies new diagnoses in a modest but clinically meaningful proportion of relatives.
These findings support MVA multiparametric prediction over the traditional left ventricular ejection fraction ≤35% threshold and allow clinically meaningful arrhythmic risk classification in patients with nonischemic dilated cardiomyopathy.
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