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B-type natriuretic peptide and survival in hypertrophic cardiomyopathy
Jeffrey B Geske1, Paul M McKie1, Steve R Ommen1
1Department of Internal Medicine, Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota.
Insights
Elevated B-type natriuretic peptide (BNP) levels in hypertrophic cardiomyopathy patients predict higher mortality risk. This finding highlights BNP as a crucial biomarker for assessing survival in hypertrophic cardiomyopathy.
Area of Science:
- Cardiology
- Biomarkers
- Genetic Heart Diseases
Background:
- Natriuretic peptides, including BNP, are released due to cardiac stress.
- These peptides indicate hemodynamic derangements in conditions like hypertrophic cardiomyopathy.
Purpose of the Study:
- To investigate the association between B-type natriuretic peptide (BNP) levels and patient survival.
- To evaluate BNP as a prognostic marker in hypertrophic cardiomyopathy.
Main Methods:
- A cohort of 772 patients with hypertrophic cardiomyopathy underwent BNP measurement.
- Echocardiography, clinical evaluation, and cardiopulmonary exercise testing were performed.
- BNP levels were analyzed in relation to survival outcomes.
Main Results:
- Higher BNP levels correlated significantly with reduced survival-free from all-cause mortality (p=0.002).
- Patients in the highest BNP tertile showed a 6.98-fold increased hazard ratio for death.
- BNP levels also correlated with functional status and need for therapy.
Conclusions:
- B-type natriuretic peptide is an independent predictor of morbidity and mortality in hypertrophic cardiomyopathy.
- BNP serves as a valuable prognostic tool for risk stratification in these patients.
Objectives:
The aim of this study was to determine the relationship between B-type natriuretic peptide (BNP) and survival in patients with hypertrophic cardiomyopathy.
Background:
Natriuretic peptides are released in response to neurohormonal activation, myocardial stretch, and wall tension and therefore reflect hemodynamic derangements.
Methods:
A total of 772 patients with hypertrophic cardiomyopathy had BNP obtained in conjunction with echocardiography and clinical evaluation, inclusive of cardiopulmonary exercise evaluation in 429 patients (56%).
Results:
Survival free of all-cause mortality was lower across increasing levels of BNP (log-rank test, p = 0.002). Three-year survival by tertile was 99.2% (95% confidence interval: 94.3% to 99.9%; BNP level ≤98 pg/ml), 94.8% (95% confidence interval: 88.2% to 97.8%; BNP level, >98 to <298 pg/ml), and 89.9% (95% confidence interval: 82.0% to 94.5%; BNP level ≥298 pg/ml). Compared with patients in the first tertile, the hazard ratios for death in the second and third tertiles were 4.88 (p = 0.006) and 6.98 (p = 0.0003), respectively. This relationship persisted in patients without resting obstructive physiology (n = 497, p = 0.01). BNP levels were related to New York Heart Association functional status (p < 0.0001) and the subsequent need for septal reduction therapy in follow-up (p = 0.04).
Conclusions:
In this large cohort of patients with hypertrophic cardiomyopathy, BNP was an independent predictor of morbidity and mortality.
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