ArticleBMC cardiovascular disorders2026
A pragmatic clinical risk score for adverse outcomes in hypertrophic cardiomyopathy using routine laboratory and bedside variables.
Article in BMC cardiovascular disorders, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundEarly risk prediction in hypertrophic cardiomyopathy (HCM) remains challenging, particularly for short-term adverse outcomes. We aimed to develop a pragmatic risk score for predicting 1-year composite adverse outcomes using routinely available clinical, laboratory, arrhythmic, and echocardiographic variables.
methodsThis single-center retrospective cohort study included 1,200 Chinese adults with HCM evaluated between 2015 and 2024. The primary endpoint was a 1-year composite of sudden cardiac death (SCD) or SCD-equivalent events, heart failure hospitalization, or all-cause mortality. Candidate predictors were selected based on clinical relevance, routine availability, and prior HCM risk evidence, followed by univariate screening and multivariable logistic regression with stepwise selection. A point-based score was developed and internally validated using 1,000 bootstrap resamples and stratified 5-fold cross-validation.
resultsDuring follow-up, 120 patients experienced the composite endpoint, including heart failure hospitalization in 78 patients, SCD or SCD-equivalent events in 24, and all-cause mortality in 18. Ten predictors were included in the HCM Pragmatic Risk Score: age ≥ 60 years, nonsustained ventricular tachycardia, unexplained syncope, maximal left ventricular wall thickness ≥ 20 mm, left atrial diameter ≥ 45 mm, left ventricular outflow tract gradient ≥ 30 mmHg, left ventricular ejection fraction < 50%, NT-proBNP > 1,000 pg/mL, elevated troponin, and creatinine > 1.2 mg/dL. The score showed moderate discrimination (AUC = 0.75) and good calibration. Event rates increased across risk strata: 3.8%, 16.7%, and 77.8%. Bootstrap validation yielded an optimism-corrected AUC of 0.74.
conclusionThe HCM Pragmatic Risk Score may assist short-term risk stratification and follow-up planning. Because the endpoint was mainly driven by heart failure hospitalization, it should not be interpreted as a dedicated SCD prediction model or stand-alone ICD decision tool. External validation is required.
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