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ObjectiveThe objective of this study was to identify prognostic factors in Hypertrophic cardiomyopathy patients with HFpEF, with a particular focus on the role of FT3 levels.Research Design and MethodsWe conducted a retrospective cohort study of 992 patients with HFpEF who were admitted to our two medical centers between 2009 and 2019. We collected demographic and clinical data, including FT3 levels, and conducted univariate and multivariate Cox analyses, KM survival curve analysis, and RSC curve analysis to identify prognostic factors and evaluate the non-linear predictive value of FT3.ResultsWe found that age, atrial fibrillation, and NT-proBNP levels were all significant prognostic factors in patients with heart failure. Additionally, FT3 levels were a significant independent predictor of all-cause mortality and cardiac transplantation. Patients with lower FT3 levels had worse long-term prognoses, and the critical value of FT3 was 2.885.ConclusionsOur findings suggest that FT3 levels are an important prognostic factor in patients with heart failure and should be considered when evaluating patient outcomes. Clinicians should monitor FT3 levels and consider interventions to maintain or improve thyroid function in patients with heart failure.Article HighlightsFT3 levels are a significant independent predictor of all-cause mortality and cardiac transplantation in Hypertrophic cardiomyopathy patients with HFpEFPatients with hypertrophic cardiomyopathy combined with HFpEF have a poorer long-term prognosis with lower FT3 levels, with a critical FT3 value of 2.885Age, atrial fibrillation, and NT-proBNP levels were also significant prognostic factors in Hypertrophic cardiomyopathy patients with HFpEFClinicians should monitor FT3 levels and consider interventions to maintain or improve thyroid function in Hypertrophic cardiomyopathy patients with HFpEF.