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medRxiv PreprintsInternational4 November 2026

Interpretable ECG manifolds link longitudinal electrical phenotypes to heart-failure risk in hypertrophic cardiomyopathy

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Hypertrophic cardiomyopathy (HCM) produces heterogeneous electrical phenotypes whose continuous organization, longitudinal evolution and clinical relevance remain poorly defined. We developed complementary variational-autoencoder representations to map HCM ECG morphology relative to physiological variation and characterize within-subject change. Using 5,194 normal-reference ECGs and 2,594 longitudinal visits from 650 individuals with HCM, we found that HCM overlapped the physiological manifold but extended towards its periphery, while an HCM-oriented manifold largely reorganized shared electri
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