Background <p>Limited studies compare the clinical applications and diagnostic values of cardiovascular magnetic resonance (CMR) versus echocardiography in individuals with hypertrophic cardiomyopathy (HCM).</p> Objective <p>This study was performed to evaluate the diagnostic value of CMR in patients with HCM.</p> Methods <p>A retrospective study without prospective follow-up was performed on the data from 100 patients diagnosed with HCM from July 2018 to December 2021. All patients underwent echocardiography, CMR scans, and late gadolinium enhancement (LGE). Various parameters of CMR were measured and compared to those of echocardiography to evaluate the diagnostic value of CMR in the diagnosis of HCM.</p> Results <p>CMR classified the patients into 6 major types based on the location of myocardial hypertrophy involvement: ventricular septal HCM (<i>n</i> = 43); apical HCM (<i>n</i> = 30); basal septal HCM (<i>n</i> = 4); mid-ventricular HCM (<i>n</i> = 13); mass‑like HCM (<i>n</i> = 1), and diffuse HCM (<i>n</i> = 9). There were 4 patients with symmetric HCM, 96 with asymmetric HCM, 41 with obstructive HCM, and 59 with non-obstructive HCM. The diagnostic accuracy rate of CMR and echocardiography for HCM was 100% and 61%, respectively, with a missed diagnosis rate of 39% (39/100). LGE showed delayed enhancement, which manifested as patchy or focal enhancement within the hypertrophied myocardium. The delayed enhancement area was limited to the hypertrophied myocardial region. CMR + LGE showed myocardial fibrosis at the apex in 62 patients. Echocardiography alone detected 17 patients apical HCM.</p> Conclusion <p>The combination of CMR with clinical symptoms may aid in the diagnosis and classification of HCM, as well as in the characterization of myocardial fibrosis. CMR appears to be superior to echocardiography in detecting missed CMR diagnoses. Further study is required to validate these findings.</p>