Cardiac magnetic resonance with late gadolinium enhancement (LGE) is a 
well-established method for in vivo detection of myocardial scarring. Several 
recent studies have investigated the prognostic value of LGE in patients with 
hypertrophic cardiomyopathy (HC). We discuss the prevalence and patterns of 
scarring in HC and its pathophysiologic significance, with focus on ventricular 
arrhythmias and sudden cardiac death. The available evidence that myocardial 
scar demonstrated by LGE is a good independent predictor of cardiac mortality in 
HC is summed up. Recommendations of current guidelines for prevention of sudden 
cardiac death in HC are discussed with regard to recent results, and the 
significance of LGE as an emerging risk factor is pointed out. In conclusion, it 
is demonstrated that LGE has incremental value in addition to clinical risk 
factors for risk stratification and management of patients with HC.