Abstract
BACKGROUND: Coronary artery disease (CAD) is common in patients with hypertrophic cardiomyopathy (HCM) and worsens prognosis. We aimed to develop a transthoracic echocardiography score (TTES) to screen for significant CAD in HCM patients. METHODS: We conducted a retrospective analysis of 392 patients with HCM concomitant with CAD at Renmin Hospital of Wuhan University. Transthoracic echocardiography assessments and logistic regression analysis were used to derive the TTES. Clinical variables were screened using the least absolute shrinkage and selection operator (LASSO) regression, and the resulting selected features were integrated with TTES for nomogram creation. RESULTS: Among the 392 patients, significant CAD was identified in 106 patients, representing 27.0% of the cohort. TTES was calculated using the following formula: -5.419 + 0.705× (left atrial end-systolic diameter, mm) + 0.114 × (E/e') + 2.583 × (obstruction of left ventricular outflow tract, yes = 1, no = 0). Patients with a high TTES were found to have a greater risk of significant CAD [odds ratio (OR), 6.46, 95% confidence interval (CI): 3.66-11.41, P<0.001]. Additionally, the area under the curve (AUC) of predictive model was 0.755 (TTES: 95% CI: 0.703-0.808; sensitivity: 67.0%, specificity: 68.2%), 0.722 (clinical model: 95% CI: 0.668-0.776; sensitivity: 84.0%, specificity: 55.2%), and 0.834 (TTES + clinical model: 95% CI: 0.791-0.876; sensitivity: 84.0%, specificity: 68.9%). CONCLUSIONS: TTES provides a clinically accessible approach integrating routine echocardiographic parameters, enabling noninvasive CAD detection in HCM patients with significant diagnostic utility.