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Aims Diastolic tissue Doppler (TD) parameters allow prediction of patients with hypertrophic cardiomyopathy (HC) at risk of sudden death, ventricular tachycardia, or cardiac arrest. The aim of this study was to assess the value of TD imaging in predicting the clinical course of patients with HC. Methods and results Eighty-six HC patients were prospectively included in the study and followed-up for clinical endpoints (cardiovascular death or hospitalization due to worsening of heart failure symptoms). Patients with clinical endpoints (n = 25) had larger left atrium diameters, thicker left ventricle (LV) walls, more often LV outflow obstruction and lower TD velocities of LV. LV outflow tract obstruction (r=0.54, R²=0.29, Pr=0.50, R²=0.25, P 4 cm/s were significantly free of clinical endpoints. Conclusion In conclusion, LMSa seems to be a reliable parameter that can be used in predicting the HC patients at risk for clinical deterioration or death at long-term follow-up. [ABSTRACT FROM AUTHOR]