The HCM Pragmatic Risk Score demonstrated moderate discrimination (AUC 0.75) for predicting 1-year adverse outcomes, with event rates of 3.8%, 16.7%, and 77.8% across risk strata.
Cohort (n=1,200)
No
Does the HCM Pragmatic Risk Score predict 1-year composite adverse outcomes in adults with hypertrophic cardiomyopathy?
The HCM Pragmatic Risk Score offers a moderately discriminative tool for short-term risk stratification of adverse outcomes, primarily heart failure hospitalization, in patients with hypertrophic cardiomyopathy.
Effect estimate: AUC 0.75
Background Early 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. Methods This 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. Results During 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 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. Conclusion The 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.
Chen et al. (Wed,) conducted a cohort in Hypertrophic cardiomyopathy (n=1,200). HCM Pragmatic Risk Score vs. Low risk stratum was evaluated on 1-year composite of sudden cardiac death, heart failure hospitalization, or all-cause mortality (AUC 0.75). The HCM Pragmatic Risk Score demonstrated moderate discrimination (AUC 0.75) for predicting 1-year adverse outcomes, with event rates of 3.8%, 16.7%, and 77.8% across risk strata.