To explore the influencing factors of coronary microcirculation dysfunction in patients with hypertrophic cardiomyopathy (HCM) and establish a prediction model.Methods 92 patients with HCM treated in our hospital from October 2019 to may 2021 were selected. All patients underwent cardiac contrast-enhanced ultrasound examination and were divided into coronary microcirculation dysfunction group (n=24) and normal group (n=68) according to the results. The clinical data of patients were collected, and the independent risk factors of coronary microcirculation dysfunction in HCM patients were analyzed by single factor and logistic regression. The risk prediction was established according to the independent risk factors, and the differentiation, accuracy and effectiveness of the model were evaluated by receiver operating characteristic (ROC) curve, Hosmer lemeshow goodness of fit test and clinical decision-making curve. Results Compared with the normal coronary microcirculation group, the NYHA grade in the abnormal group was worse, the lymphocyte count, LDL-C, ALB and LVEF decreased significantly, and hs- CRP, NT-proBNP, Cys-C, hs-cTnI, LVEDD and LAD increased significantly (P＜0.05). The higher NYHA grade, the lower LVEF and the increase of NT-proBNP, hs-cTnI and LVEDD were independent risk factors for coronary microcirculation dysfunction in patients with HCM (P＜0.05).The nomogram prediction model was constructed by using the above independent risk factors. The consistency index (c-index) was 0.756 (95% CI:0.684～0.830), and the AUC of ROC curve was 0.895 (95% CI: 0.866～0.915). The evaluation results of calibration curve and clinical decision curve suggest that the accuracy and effectiveness of the model are good. Conclusion The higher NYHA grade, the lower LVEF and the increase of NT-proBNP, hs-cTnI and LVEDD are independent risk factors of coronary microcirculation dysfunction in patients with HCM, the nomogram prediction model has a certain reference value for risk assessment