Genotype Predicts Heart Failure Independent of LVEF, Peak VO2, and NT-proBNP Levels in Hypertrophic Cardiomyopathy

BACKGROUND: Hypertrophic cardiomyopathy (HCM) is a myocardial disorder characterized by left ventricular hypertrophy and progression to heart failure (HF). Approximately 40% of cases are caused by variants in genes encoding sarcomere proteins. OBJECTIVES: This study sought to determine the relationship between genotype and other clinical predictors of HF outcomes in HCM patients. METHODS: , and left ventricular ejection fraction (LVEF). RESULTS: (HR: 0.90; 95% CI: 0.82-0.98; P < 0.001), and LVEF (HR: 0.74 per 5% increment; 95% CI: 0.63-0.86; P < 0.001) were independently associated with HF outcomes. For secondary endpoints, 60 patients (11.9%) died of cardiac causes, 34 (6.7%) experienced arrhythmic events, and 115 (22.8%) died of any cause. CONCLUSIONS: , log NT-proBNP, and LVEF independently predict HF outcomes in HCM. Combining genotype with HF biomarkers and functional capacity measures identifies patients at increased risk of HF-related death or transplant and may support targeted monitoring and selection for disease-modifying trials.