Influencing factors of major cardiovascular adverse events in non-obstructive hypertrophic cardiomyopathy and the construction and validation of nomogram prediction model
WANG Yu
YANG Yanfang
Abstract：Objective To investigate the influencing factors of major adverse cardiovascular events(MACE)in non-obstructive hypertrophic cardiomyopathy(NHCM)and to construct and validate a nomogram prediction model.Methods A total of 200 NHCM patients admitted from September 2021 to September 2022 were selected as the modeling set.According to the ratio of 7∶3,86 NHCM patients admitted from October 2022 to October 2023 were selected as the validation set.Patients in the modeling set were divided into MACE group(n=55)and non-MACE group(n=145)according to whether MACE occurred within 2 years.The general data and myocardial work parameters measured by echocardiography were compared between MACE group and non-MACE group.Logistic regression was used to analyze the influencing factors of MACE in NHCM patients,and the rms package of R software(version 4.3.0)was used to construct the nomogram prediction model.Calibration curve was drawn to evaluate the calibration of the prediction model;the receiver operating characteristic(ROC)curve was drawn to evaluate the discrimination of the prediction model,and the validation set data was used for external verification.Results The age,proportion of patients with unexplained syncope,atrial fibrillation,heart failure,and fragmented QRS waves(fQRS),and N-terminal pro-brain natriuretic peptide(NT-proBNP)levels in the MACE group were higher than those in the non-MACE group,while the left ventricular ejection fraction(LVEF),global work index(GWI),gross conbustible work(GCW),and global work efficiency(GWE)were lower than those in the non-MACE group(P＜0.05,P＜0.01).Age,unexplained syncope,atrial fibrillation,heart failure,fQRS,and NT-proBNP were risk factors for MACE in patients with NHCM,while LVEF,GWI,GCW,and GWE were protective factors.After adjusting for age,unexplained syncope,atrial fibrillation,heart failure,fQRS,NT-proBNP,and LVEF,GWI,GCW,and GWE remained protective factors for MACE in patients with NHCM(P＜0.05,P＜0.01).The area under the curve(AUC)of the new nomogram prediction model established by combining conventional influencing factors with GWI,GCW,and GWE was 0.940(95％CI:0.902,0.977).Calibration curve and ROC curve showed that the new nomogram prediction model had high calibration and predictive performance for MACE.Conclusion GWI,GCW and GWE are still protective factors for MACE in NHCM patients after adjusting for conventional influencing factors.The nomogram prediction model established by the combination of GWI,GCW and GWE with conventional influencing factors has good predictive ability and high accuracy in the validation set,which can provide reference for clinical MACE prevention and treatment decisions.
Keywords：non-obstructive hypertrophic cardiomyopathymajor adverse cardiovascular eventsN-terminal pro-brain natriuretic peptideleft ventricular ejection fractionglobal work indexglobal work efficiencynomogram prediction model
Publication Date：2026-01-28
Online Publishing Date：2026-02-05(First online date of this platform, not the publication date of the document)
Pages：10( 25-33,48 )