MYH7 and hypertrophy: Whether this heterogeneity reflects mutation-specific clinical trajectories remains a pivotal question for prognostication and personalized management.<h4>Objectives</h4>This study aimed to determine if pathogenic sarcomeric variants in <i>MYH7</i> and <i>MYBPC3</i> are associated with distinct clinical pathways in obstructive HCM, by comparing their associations with age at presentation, severity of hypertrophy, left ventricular outflow tract (LVOT) obstruction, and arrhythmic outcomes.<h4>Methods</h4>We conducted a systematic review and meta-analysis following PRISMA 2020 guidelines.