Improving Risk Stratification in Hypertrophic Cardiomyopathy: A Novel Score Combining Echocardiography, Clinical, and Medication Data

Marion Taconné; Valentina D. A. Corino; Annamaria Del Franco; Sara Giovani; Iacopo Olivotto; Adrien Al Wazzan; Erwan Donal; Pietro Cerveri; Luca Mainardi

arXiv · 2603.26254

Improving Risk Stratification in Hypertrophic Cardiomyopathy: A Novel Score Combining Echocardiography, Clinical, and Medication Data

Marion Taconné·Valentina D. A. Corino·Annamaria Del Franco·Sara Giovani·Iacopo Olivotto·Adrien Al Wazzan·Erwan Donal·Pietro Cerveri·Luca Mainardi

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Abstract

Hypertrophic cardiomyopathy (HCM) requires accurate risk stratification to inform decisions regarding ICD therapy and follow-up management. Current established models, such as the European Society of Cardiology (ESC) score, exhibit moderate discriminative performance. This study develops a robust, explainable machine learning (ML) risk score leveraging routinely collected echocardiographic, clinical, and medication data, typically contained within Electronic Health Records (EHRs), to predict a 5-year composite cardiovascular outcome in HCM patients. The model was trained and internally validated using a large cohort (N=1,201) from the SHARE registry (Florence Hospital) and externally validated on an independent cohort (N=382) from Rennes Hospital. The final Random Forest ensemble model achieved a high internal Area Under the Curve (AUC) of 0.85 +- 0.02, significantly outperforming the ESC score (0.56 +- 0.03). Critically, survival curve analysis on the external validation set showed superior risk separation for the ML score (Log-rank p = 8.62 x 10^(-4) compared to the ESC score (p = 0.0559). Furthermore, longitudinal analyses demonstrate that the proposed risk score remains stable over time in event-free patients. The model high interpretability and its capacity for longitudinal risk monitoring represent promising tools for the personalized clinical management of HCM.

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Marion Taconné, Valentina D. A. Corino, Annamaria Del Franco, Sara Giovani, Iacopo Olivotto, Adrien Al Wazzan, Erwan Donal, Pietro Cerveri, Luca Mainardi. 2026-03-27. Improving Risk Stratification in Hypertrophic Cardiomyopathy: A Novel Score Combining Echocardiography, Clinical, and Medication Data. https://arxiv.org/abs/2603.26254

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