Inflammatory and Nutritional Indices Associated with Myocardial Scar on Cardiac MRI in Hypertrophic Cardiomyopathy: A Retrospective, Single-Center Study

Background/Objectives: Hypertrophic cardiomyopathy (HCM) is characterized by myocardial hypertrophy and fibrosis, while low-grade systemic inflammation may contribute to adverse myocardial remodeling. We investigated the relationship between routinely available inflammatory and nutritional indices and late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) and explored a simple biomarker–structural score for identifying patients with LGE positivity. Methods: This retrospective, cross-sectional, single-center study included 197 adults with HCM who underwent CMR and laboratory testing within one week. Ten inflammatory and nutritional indices were evaluated, with Benjamini–Hochberg false-discovery rate (FDR) correction for multiple comparisons. LGE-positive patients were additionally stratified by scar burden. Multivariable logistic regression examined laboratory and structural correlates of LGE. An exploratory 0–5 biomarker–structural score assigned one point each for albumin < 40 g/L, erythrocyte sedimentation rate (ESR) ≥ 5 mm/h, hs-Troponin T ≥ 14 ng/L, NT-proBNP ≥ 125 pg/mL, and interventricular septal thickness (IVS) ≥ 1.8 cm. Discrimination was assessed by ROC analysis, and internal stability was examined using 1000 bootstrap resamples. Results: Among 197 patients, 127 (64.5%) were LGE-positive. After FDR correction, higher NLR × CRP index, CAR, and PLR × CRP index and lower PNI were associated with LGE positivity, while the NLR × CRP index, CAR, and PNI remained associated with increasing LGE burden. Lower albumin, higher ESR, NT-proBNP ≥ 125 pg/mL, and greater IVS thickness were independently associated with LGE positivity. The exploratory five-component score yielded an AUC of 0.818, with a mean bootstrap AUC of 0.820. Conclusions: In HCM, routinely available inflammatory and nutritional indices were associated with LGE-defined myocardial scar, with the NLR × CRP index, CAR, and PNI showing the most consistent relationships with LGE burden. A simple exploratory score integrating inflammatory/nutritional status, systemic inflammation, myocardial injury, hemodynamic stress, and septal hypertrophy showed an apparent AUC of 0.818 for LGE positivity, supporting further evaluation in independent HCM cohorts.