A study recently published in ESC Heart Failure explored the relationship between the fibrosis-4 index (FIB-4) and long-term major adverse cardiovascular events (MACE) in patients with HCM. The researchers divided 187 patients (mean age 66.49 ±11.43 years, 34.8% female) into two groups based on a FIB-4 cutoff value of 2.37. Patients with FIB-4 2.37 or greater had a higher prevalence of comorbidities, including atrial fibrillation (27.7% vs 7.9%; P<0.001) and heart failure (55.3% vs 24.3%; P<0.001). Over a median follow-up of 41 months, MACE occurred more frequently in the higher FIB-4 group (58.8% vs 25.7%; P<0.001), with higher cardiac death rates (20.6% vs 2.7%; P=0.001). FIB-4 scores of 2.37 or greater were independently associated with an increased risk for MACE (aHR, 1.919; 95% CI 1.015-3.630; P=0.045) and cardiac death (aHR, 9.518; 95% CI 1.718-52.732; P=0.010). The FIB-4 positively correlated with left atrium diameter, septal thickness, posterior wall thickness, and n-terminal pro b-type natriuretic peptide, while it negatively correlated with left ventricular ejection fraction.