ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. General Cardiovascular Medicine
Comprehensive Risk Stratification Model for Sudden Death in Hypertrophic Cardiomyopathy: Integration of Cardiac Magnetic Resonance and Clinical Parameters
Tao Guo 1
Hexun Ding 2
Xiaoli Chen 2
Wei Dong 2
Jiarui Liang 2
Tan Zhang 2
Meifa Feng 2
Li Zhang 3
Shijian Chen 2
1. Department of Cardiology, Zhongnan Hospital of Wuhan university, Wuhan, China
2. Department of Cardiology, Yangxin County People's Hospital, Yangxin, Hubei, China
3. Lichuan Ethnic Hospital of Traditional Chinese Medicine, Lichuan, Hubei, China
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Abstract
Background: Current risk stratification for sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM) relies primarily on the HCM Risk-SCD score, but its predictive accuracy remains suboptimal. Objectives: This study aimed to develop and validate a comprehensive risk prediction model integrating cardiac magnetic resonance (CMR) parameters with clinical and biomarker variables. Methods: We analyzed 576 consecutive HCM patients from a tertiary referral center. The primary endpoint was sudden death or appropriate implantable cardioverter-defibrillator therapy. We developed four prediction models: 1) Traditional (HCM Risk-SCD alone), 2) Clinical (traditional + clinical variables), 3) CMR (traditional + CMR parameters), and 4) Comprehensive (integrating all variables). Model performance was assessed using C-index and time-dependent receiver operating characteristic (ROC) analysis. Results: During median follow-up of 3 years, 58 patients (10.1%) experienced the primary endpoint. The comprehensive model demonstrated superior performance (C-index 0.607) compared to traditional (0.565), clinical (0.598), and CMR (0.607) models. In multivariable analysis, CMR ejection fraction (HR 0.94, 95% CI 0.91-0.97, P<0.001) and left ventricular diastolic pressure (HR 0.94, 95% CI 0.89-0.98, P=0.010) were independent predictors. Time-dependent ROC analysis showed maintained predictive accuracy over 3 years (AUC 0.78-0.85). Risk stratification using the comprehensive model effectively discriminated low, intermediate, and high-risk groups (log-rank P<0.001). Conclusions: Integration of CMR parameters with clinical variables significantly improves SCD risk prediction in HCM compared to traditional risk stratification. The comprehensive model provides enhanced accuracy for identifying high-risk patients who may benefit from primary prevention implantable cardioverter-defibrillator therapy.
Summary
Keywords
cardiac magnetic resonance, Hypertrophic Cardiomyopathy, Prediction model, risk stratification, Sudden cardiac death
Received
18 December 2025
Accepted
13 February 2026
Copyright
© 2026 Guo, Ding, Chen, Dong, Liang, Zhang, Feng, Zhang and Chen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Tao Guo
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