HCM: A disease of energy deficiency

HCM: A disease of energy deficiency. ADP = adenosine diphosphate; AMP = adenosine monophosphate; ATP = adenosine triphospate; Cr = creatine; FAM = fatty acid metabolism. [Source]

As indicated in red, the phenotype of hypertrophic cardiomyopathy (HCM) can arise from:

1. Excessive energy use (e.g., by aberrant sarcomeres);
2. Inadequate energy production (e.g., from poorly functioning mitochondria), inadequate metabolic substrates, or a failure to transfer energy across cellular compartments owing to cytoarchitectural defects as exemplified by muscle LIM protein (MLP) mutations; or 
3. Aberrant signaling of energy deficiency (e.g., with AMP-activated protein kinase [AMPK] mutations).

The final common path for these diverse defects is energy deficiency and ensuing hypertrophy.

Further reading:

1. Ashrafian H, Watkins H. Reviews of Translational Medicine and Genomics in Cardiovascular Disease: New Disease Taxonomy and Therapeutic Implications -- Cardiomyopathies: Therapeutics Based on Molecular Phenotype. J Am Coll Cardiol. 2007;49(12):1251-1264. [Medscape]