Key result
Novel six-variable model predicts heart failure death in HCM with ~0.90 1-year AUROC.
Why the study?
Heart failure is a major cause of death in patients with hypertrophic cardiomyopathy, but a validated prediction model for HF-related death in this population was unavailable.
Does a six-variable multivariable prediction model accurately predict heart failure-related death in patients with hypertrophic cardiomyopathy?
Cohort (n=4,020)
Yes
Does a six-variable multivariable prediction model accurately predict heart failure-related death in patients with hypertrophic cardiomyopathy?
This multicenter study developed and externally validated a novel six-variable clinical prediction model that accurately predicts 1- and 5-year heart failure-related death in patients with hypertrophic cardiomyopathy, including those with preserved LVEF.
May aid HF death risk stratification in HCM; leaves open prospective validation before clinical adoption.
Background Heart failure (HF) is one of the major causes of death in patients with hypertrophic cardiomyopathy (HCM). However, a validated prediction model for HF-related death in this population remains unavailable. Purpose This study aimed to develop and validate a prediction model for HF-related death in patients with HCM. Methods A total of 4,020 patients with HCM from five medical centers were enrolled. The development cohort contained 2,885 patients from one large center, and other four independent centers (n=1,135) served for external validation. The endpoint was HF-related death. A multivariable Cox proportional hazards model was constructed to develop the prediction model. External validation was conducted to assess model generalizability in independent cohorts. Model performance was evaluated using the time-dependent area under the receiver operating characteristic curve (AUROC). Results During a median follow-up of 5.3 years, HF-related death occurred in 57 patients (2.0%) in the development cohort. In the combined external validation cohort, 20 patients (1.8%) experienced HF-related death over a median follow-up of 3.5 years. The final HF-related death prediction model incorporated age at visit, New York Heart Association functional class, systolic blood pressure, N-terminal pro-B-type natriuretic peptide, left ventricular ejection fraction (LVEF), and left atrial diameter. The model achieved AUROCs of 0.88 (0.81−0.95) and 0.86 (0.81−0.92) for predicting HF-related death at 1 and 5 years in the development cohort, and 0.90 (0.80−0.99) and 0.85 (0.73−0.97) in the external validation cohort. Among patients with preserved LVEF, the model also demonstrated good performances at both time points, with AUROCs of 0.85 (0.77−0.93) and 0.86 (0.79−0.92) in the development cohort, and 0.86 (0.74−0.99) and 0.80 (0.64−0.96) in the external validation cohort, respectively. Conclusions In this multicenter study, we developed and externally validated a six-variable prediction model for HF-related death in patients with HCM. The model also showed robust performance in patients with preserved LVEF.
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Zhang et al. (2026) conducted a cohort in Hypertrophic cardiomyopathy (n=4,020). Six-variable prediction model (age, NYHA class, SBP, NT-proBNP, LVEF, left atrial diameter) was evaluated on Heart failure-related death (AUROC 0.90 (1-year validation) and 0.85 (5-year validation), 95% CI 0.80-0.99 (1-year) and 0.73-0.97 (5-year)). A novel six-variable prediction model predicted HF-related death in hypertrophic cardiomyopathy with validation AUROCs of 0.90 (95% CI 0.80-0.99) at 1 year and 0.85 (95% CI 0.73-0.97) at 5 years.
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