To explore the relationship between BigET-1 and cardiac remodeling in hypertrophic obstructive cardiomyopathy (HOCM). A retrospective analysis was conducted on the data of 150 HOCM patients in a hospital from September 2021 to August 2023. According to the 2015 American Ultrasound Society's recommended standards for quantifying adult UGG cardiac lumen, left atrial enlargement is defined as having a left atrial diameter greater than 40 mm in males and greater than 38 mm in females. 150 HOCM patients were divided into a left atrial normal group (n = 97) and a left atrial enlargement group (n = 53). Comprehensive patient data were collected, including BigET-1in plasma, N-Terminalpro-B-TypeNatriureticPeptide (NT-pro-BNP), and High-sensitive C-reactive protein (Hs-CRP), as well as cardiac magnetic resonance imaging (CMR) imaging data. The relationship between BigET-1 levels and cardiac remodeling was analyzed. The two groups had no statistical difference in gender, age, heart rate, dyspnea, angina pectoris, etc. (P > 0.05). The chi(2)-test showed that patients in the left atrial enlargement group had an increased proportion of atrial fibrillation compared to those in the left atrial normal group (P < 0.05). Non parametric tests showed that the Big ET-1 and NT-pro-BNP in the left atrial enlargement group were significantly higher than those in the left atrial normal group (P < 0.05). The t-test results showed that there were statistical differences in Hs-CRP, left atrial anteroposterior diameter, interventricular septum thickness, and LVEDV between the left atrial enlargement group and the left atrial normal group (P < 0.05). Pearson correlation analysis showed that Big ET-1 was positively correlated withNT-pro-BNP, Hs-CRP, left atrial anteroposterior diameter, and interventricular septum thickness (P < 0.05). The multiple linear regression analysis showed that Big ET-1 was positively correlated with NT-pro-BNP and LADap (P < 0.05). In HOCM patients with atrial enlargement, the Big ET-1 is significantly elevated. Cardiac remodeling is more pronounced, indicating that Big ET-1 plays a role in cardiac remodeling in HOCM patients.