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Increased brain natriuretic peptide secretion is a marker of disease progression in nonobstructive hypertrophic

Maurizio Pieroni1, Fulvio Bellocci, Tommaso Sanna

  • 1Cardiology Department, Catholic University, Rome, Italy.

Journal of Cardiac Failure
|July 3, 2007
PubMed

Insights

Progression of hypertrophic cardiomyopathy (HCM) to dilated phase increases both plasma and myocardial brain natriuretic peptide (BNP). Serial plasma BNP may noninvasively detect hemodynamic decline in HCM patients.

Area of Science:

  • Cardiology
  • Biochemistry

Background:

  • Hypertrophic cardiomyopathy (HCM) is linked to elevated plasma brain natriuretic peptide (BNP).
  • Sequential assessment of plasma and myocardial BNP in stable and dilated HCM is not well-documented.

Purpose of the Study:

  • To investigate sequential changes in plasma and myocardial BNP in patients with hypertrophic cardiomyopathy (HCM) as they progress to the dilated phase.
  • To correlate these changes with hemodynamic parameters and assess the potential for noninvasive monitoring.

Main Methods:

  • Forty HCM patients underwent cardiac catheterization, angiography, and left ventricular (LV) endomyocardial biopsy.
  • Patients were followed for progression to dilated phase, with a second invasive study including LV biopsy for those who progressed.
  • Plasma BNP levels were measured at baseline and follow-up; biopsies were analyzed for BNP expression via immunohistochemistry.

Main Results:

  • Patients progressing to dilated HCM (Group 2) showed significantly increased plasma BNP and elevated LV/right ventricular end-diastolic pressures compared to stable patients (Group 1).
  • Immunohistochemistry revealed a significant increase in myocardial BNP-positive myocytes in follow-up biopsies of Group 2 patients.
  • Increased myocardial BNP strongly correlated with elevated LV end-diastolic pressure and plasma BNP levels.

Conclusions:

  • Progression to end-stage HCM is marked by increased myocardial and plasma BNP.
  • Serial plasma BNP measurements may serve as a noninvasive indicator of hemodynamic deterioration in HCM.
  • Prompt monitoring of plasma BNP could facilitate timely initiation of heart failure therapy.
Abstract

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