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Introduction: Hypertrophic cardiomyopathy (HCM) has genetic and phenotypic heterogeneity. Many studies have related the size of the left atrium (LA) with worse prognosis in HCM patients, demonstrating a relationship between the presence of atrial fibrillation, worse functional class and even sudden death. The aim of this study is to analyze the predictive value of demographic, clinical, morphological and functional variables of HCM with LA size.Materials and Methods: We prospectively studied 86 HCM (63 men, 55 ± 14 years old) from two tertiary centers (Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentine and Centro Cardiovascular Sant Jordi, Barcelona, Spain). Twenty seven patients (pts) with obstructive HCM, 37 with non-obstructive HCM and 22 with apical HCM. Pts were clinically evaluated and studied by echocardiography (conventional and tissue Doppler) to assess the presence of left ventricular obstruction and left ventricular function. Left atrial size was evaluated using 3D echocardiography, measuring the maximum volume of the LA. Cardiac magnetic resonance imaging (CMR) was performed to characterize morphological subtype of HCM, to quantify the left ventricular mass (LVM) and the presence and extent of myocardial interstitial fibrosis using myocardial gadolinium late enhancement.Results: Mean atrial volume in the whole population was 25.4 ± 11.7 ml/m2. Univariate analysis showed that age, female gender, mitral regurgitation, functional class, obstructive forms, the E/e' and the score of fibrosis was associated with bigger LA volume. In multivariate analysis, age (p = 0.03), female gender (p = 0.02), fibrosis score (p = 0.01) and severe mitral regurgitation (p = 0.009) where predictors of increased LA volume.Conclusions: In patients with any type of HCM increased left atrial volume was associated with older age and female gender. The degree of interstitial myocardial fibrosis assessed by CMR and the presence of severe mitral regurgitation also predict left atrial enlargement.