Objective: To explore the value of myocardial strain analysis based on deformable registration algorithm (DRA) in the diagnosis of hypertrophic cardiomyopathy (HCM) and its relationship with prognostic risk factors. Methods: Twenty- three patients who were diagnosed as HCM in our hospital with (50.70±14.80) years old were collected retrospectively.In addition, 23 volunteers who matched the age and sex were also recruited. All volunteers underwent a cardiac MRI (CMR) scan consistent with the patients with HCM. According to the presence or absence of late gadolinium enhancement (LGE), the HCM group was divided into non-enhanced [LGE(-)] subgroup andenhanced [LGE(+)] subgroup.Images of patients with HCM and volunteers were analyzed using the DRA-based myocardial deformation post-processing software named TrufiStrain. The measurement parameters includedglobal peak radial strain (GPRS), global peak circumferential strain (GPCS), global peak longitudinal strain (GPLS), and peak radial, circumferential and longitudinal strain(PRS, PCS, and PLS) of different parts of the left ventricle (the apex, the middle of left ventricle, and the base). Student-t test or Mann-Whitney, Pearson correlation analysis, ROC curve were used to statistically analyze the diagnostic efficacy of myocardial deformation parameters in HCM and its relationship with left ventricular wall thickness and LGE. Results: Other than apical PCS, all GPRS, GPCS, GPLS, basal and medial PRS, PCS, PLS, and apical PRS, PLS in patients with HCM were significantly lower than those in healthy volunteers (P<0.05). The global, apical, basal and medial radial, circumferential and longitudinal strain and strain rate of the patients with HCM were significantly smaller than those of the control group (P<0.05). The basal and medial PRS, PCS, PLS of both the control group and the LGE(-) subgroup were significantly higher than those in LGE (+) subgroup (P<0.05). The ratio of radialstrain rate during early and late diastole (REL）, circumferentialstrain rate during early and late diastole (CEL) and longitudinal strain rate during early and late diastole (LEL) of patients in LGE (+) subgroup were smaller than those in LGE(-) subgroup and the control group (P<0.05). GPRS, GPCS, GPLS, REL, CEL and LEL were all significantly correlated with the maximum thickness of left ventricular myocardium (P<0.05). ROC curve analysis showed that areas under the curve of GPRS, GPCS, GPLS, REL, CEL and LEL for the diagnosis of HCM were 0.686, 0.905, 0.921, 0.972, 0.974 and 0.917, respectively. The areas under the curve of GPRS, GPCS, GPLS, REL, CEL and LEL for predicting LGE in patients with HCM were greater than 0.871. Conclusions: DRA-based myocardial deformation analysis is of great value in diagnosing HCM and predicting LGE in HCM patients and is closely correlated to myocardial thickness.