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The aim of our study was to assess the performance of the new American College of Cardiology (ACC)/American Heart Association (AHA) Guidelines, with respect to sudden cardiac death (SCD) prevention, in comparison with the established risk score of the European Society of Cardiology (hypertrophic cardiomyopathy [HCM] Risk-SCD), in a large Mediterranean cohort of HCM patients. The clinical and imaging characteristics of 784 HCM patients (mean age at first evaluation 52±16years, 67.2% males) were analyzed retrospectively. The sensitivity,