There were great advances in the treatment of heart failure (HF) over the past decades, characterised by the inclusion of ARNI and SGLT2 inhibitors in the latest guidelines. The use of cardiac myosin inhibitors specifically for patients with hypertrophic cardiomyopathy (HCM) is also making large steps forward, which reflects the next step towards more personalised treatment.1 The increasing repertoire of treatments makes it even more important to select those patients who will benefit the most from these therapies. However, the diagnostic markers to make this selection are still limited to the usual suspects: left ventricular ejection fraction, New York Heart Association (NYHA) class and N-terminal pro-B-type natriuretic peptide (NT-proBNP). Better identification of those patients who are at high risk of deterioration, and would benefit the most from additional therapy, could reduce the burden of HCM and lower the need for hospitalisation and/or heart transplantation.

Proteomics profiling allows us to measure thousands of plasma proteins at one specific timepoint. Such analysis can be used for two different purposes: (1) to find novel biomarkers that can help us in this risk stratification or (2) to find clusters of increased proteins that could indicate activity of specific pathophysiological pathways and thus provide mechanistic insights. The use of proteomics for these purposes in different cardiovascular diseases has exponentially increased over the last years, mainly due to improved methodology and lower costs. Therefore, proteomics profiling could provide answers to the outstanding questions in the risk stratification of HCM patients.

Lumish et al 2 applied the use op proteomics profiling in HCM patients in a multicentre, prospective cohort study to determine whether proteomics can predict worsening of HF in HCM patients and to identify pathophysiological pathways associated with worsening of HF. In this well-designed study, 389 patients with HCM were included, and plasma proteomics profiling …