What is the clinical evidence from this study?

Study design: Case-Control. Population: Hypertrophic Cardiomyopathy (HCM) with Heart Failure (HF) (n=311). Intervention: Diagnostic nomogram (incorporating BNP, diuretic use, and myocardial ischemia). Primary outcome: Diagnostic accuracy (Area Under the Curve) of the nomogram for identifying heart failure in the validation set (AUC 0.929, 95% CI 0.873-0.984).

What question did this study set out to answer?

This study aims to develop and validate a diagnostic nomogram to identify heart failure in patients with hypertrophic cardiomyopathy using routine clinical indicators.

May 10, 2026Open Access

Construction and verification of a diagnostic nomogram for heart failure in hypertrophic cardiomyopathy based on conventional clinical indicators: a case-control study

Key Result

A diagnostic nomogram incorporating B-type natriuretic peptide, diuretic use, and myocardial ischemia accurately identified heart failure in patients with hypertrophic cardiomyopathy, achieving an AUC of 0.929 in the validation cohort.

Key Points

This study aims to develop and validate a diagnostic nomogram to identify heart failure in patients with hypertrophic cardiomyopathy using routine clinical indicators.
Case-control study design
Utilized clinical indicators, including B-type natriuretic peptide and diuretics
Registered at the Chinese Clinical Trial Registry (ChiCTR2500106648)
Nomogram achieved an AUC of 0.917 in the training set and 0.929 in the validation set
Sensitivity and specificity of the training set were 89.1% and 79.9%, respectively
Sensitivity and specificity of the validation set were 90.9% and 82.9%, respectively

Study Design

Type

Case-Control (n=311)

Multicenter

Structured PICO

Does a diagnostic nomogram based on BNP, diuretic use, and myocardial ischemia accurately identify heart failure in patients with hypertrophic cardiomyopathy?

Population

311 patients with hypertrophic cardiomyopathy (HCM) admitted to the Cardiology Department of Wuhan Central Hospital between December 2022 and December 2024. 195 (62.7%) male, 116 (37.3%) female. 77 diagnosed with HF. Excluded: incomplete clinical data, active malignant tumors with expected survival < 1 year, congenital heart disease, primary severe valvular disease, active infection, acute myocardial infarction, myocarditis, pericarditis, and other clear causes of acute HF.

Intervention

Diagnostic nomogram incorporating B-type natriuretic peptide (BNP), diuretic use, and myocardial ischemia

Outcome

Identification of heart failure (HF)

Main Result

Effect estimate: AUC 0.929 (95% CI 0.873-0.984)

Limitations

Single-center retrospective design
Lacked an independent, prospective, multi-center external validation cohort
All participants were of East Asian descent and recruited from a single city, limiting generalizability
Reliance on complete-case analysis without imputation for missing data
Absence of a predefined model-update strategy
Inability to perform NRI/IDI comparisons because no established HF risk tools exist for HCM
Model lacks parameters like delayed enhancement of cardiac magnetic resonance and genotypes

Abstract

Heart failure (HF) manifests variably in patients with hypertrophic cardiomyopathy (HCM). This study developed and validated a diagnostic nomogram that uses routine clinical indicators to identify HF in individuals with HCM. Independent diagnostic indicators of HF in patients with HCM included B-type natriuretic peptide (BNP) (OR = 1.003, P < 0.001), diuretics (OR = 3.69, P = 0.014), and myocardial ischemia (OR = 4.99, P = 0.002). The diagnostic model demonstrated robust performance in both the training set and the validation set, yielding AUCs of 0.917 (95% CI: 0.879-0.955) and 0.929 (95% CI: 0.873-0.984), respectively. At an optimal threshold of 0.157, the training set exhibited sensitivity and specificity of 89.1% and 79.9%, respectively, while the validation set showed sensitivity and specificity of 90.9% and 82.9%, respectively. The calibration curve indicated a good fit, and DCA revealed that the model provided a net clinical benefit. In this study, the developed nomogram model accurately identifies HF in patients with HCM, aiding in diagnostic stratification and personalized management.Clinical Trial Registration This study was registered retrospectively at the Chinese Clinical Trial Registry ( http://www.chictr.org.cn/ ), registration number ChiCTR2500106648 (Registration Date: 2025-07-28).

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