• late gadolinium enhancement
• hypertrophic cardiomyopathy
• female
• cardiac magnetic resonance
• sex

Hypertrophic cardiomyopathy (HCM) is a familiar cardiac disease with autosomal dominant inheritance, characterized by a heterogeneous clinical expression and variable prognosis (1). Previous studies reported a worst prognosis and a late diagnosis in females compared to males, nevertheless its inheritance should not be influenced by the gender (2, 3). Cardiac magnetic resonance (CMR) permitted to increase the diagnostic spectrum in higher number of patients including those with an apical or lateral pattern of hypertrophy (4). The course of the disease may include episodes of atrial fibrillation (AF), stroke, heart failure (HF), even if sudden cardiac death (SCD) remains the most dramatic complication of HCM; a typical substrate of arrhythmias is represented by myocardial fibrosis, not-invasively detected by CMR, as Late Gadolinium Enhancement (LGE) (5). LGE is related to malignant ventricular arrhythmias also in patients with a low-intermediate ESC risk score for sudden cardiac death, who should not benefit from an implantable cardioverter defibrillator (ICD) implantation in primary prevention (6-7). However, in Literature, it is reported a significant relation between LGE extent, expressed in terms of percentage of left ventricular mass, and a worse prognosis (8-10). The aim of our study was to evaluate CMR findings, particularly LGE, to predict an unfavorable outcome, including a composite end point in addiction to arrhythmic events, in patients with 5-years ESC low-intermediate risk score of SCD and the presence of sex-related differences.