B-Type Natriuretic Peptide and Survival in Hypertrophic Cardiomyopathy

Study Questions:

What is the relation between B-type natriuretic peptide (BNP) and survival in patients with hypertrophic cardiomyopathy (HCM)?

Methods:

A total of 772 patients with HCM were evaluated retrospectively at a single center with plasma BNP levels and two-dimensional transthoracic echocardiography checked at time of evaluation. Of those, cardiopulmonary exercise was performed in 429 patients.

Results:

The mean age was 52 ± 16 years (62% male); 61% of patients had mild or no symptoms (New York Heart Association [NYHA] class I or II). Median BNP for the entire study population was 177.5 (interquartile range [IQR], 71-395) pg/ml. BNP was related to both peak VO2 (Spearman = -0.44, p < 0.0001) and percent predicted VO2 achieved during cardiopulmonary exercise testing (Spearman = -0.33, p < 0.0001). BNP levels were related to NYHA functional status (p < 0.0001) and the subsequent need for septal reduction therapy in follow-up (p = 0.04). Patients who died had higher BNP levels than survivors (288.5 [IQR, 214-573.8] vs. 168.5 [IQR, 68.8-387.3] pg/ml, Wilcoxon p = 0.002). Survival free of all-cause mortality was worse across all levels of BNP (log-rank p = 0.002). BNP also was a significant predictor of death in patients without obstructive physiology at rest (n = 497, p = 0.01).

Conclusions:

The authors concluded that BNP is an independent predictor of survival in patients with HCM, and elevated BNP levels can reflect patients who have poor cardiopulmonary exercise tolerance with HCM.

Perspective:

This is the largest longitudinal study of BNP in HCM patients. The use of biomarkers should be considered when risk stratifying patients with HCM.

Clinical Topics: Heart Failure and Cardiomyopathies, Noninvasive Imaging, Acute Heart Failure, Heart Failure and Cardiac Biomarkers, Echocardiography/Ultrasound

Keywords: Exercise Tolerance, Heart Diseases, Natriuretic Peptides, Follow-Up Studies, Biological Markers, Troponin I, Cardiomyopathies, Heart Failure, New York, Atrial Natriuretic Factor, Echocardiography


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