RESUMO
INTRODUCTION: N-terminal pro-B-type natriuretic peptide (NT-proBNP) can be a marker of left ventricle (LV) pressure overload in hypertrophic cardiomyopathy (HCM). The different clinical characteristics of HCM might correspond to the degree of NT-proBNP increase. AIM: This study aimed to establish whether the left atrium (LA) dimension, left ventricle outflow tract (LVOT) gradient, and pulmonary hypertension influence NT-proBNP serum levels in patients with HCM. MATERIAL AND METHODS: In 62 HCM patients (32 males and 30 females, mean age 31 ±11 years), echocardiography with LV outflow tract gradient provocation was performed using natural stimuli > 30 mm Hg (NOHCM - 36 patients, POHCM - 12 patients, HOCM - 14 patients). RESULTS: Smaller LAD was associated with a lower NT-proBNP/ULN level (p = 0.001). In contrast, smaller vs. larger LAD subgroups did not differ in NT-proBNP level (p = 0.42). Both NT-proBNP/ULN and NTproBNP were significantly elevated in the subgroup with lager LAA. The absolute value of NT-proBNP was significantly higher in the HOCM subgroup (NOHCM vs. POHCM vs. HOCM (p = 0.02). Similarly, NT-proBNP/ULN was significantly higher in the HOCM subgroup (NOHCM vs. POHCM vs. HOCM, p = 0.00047). This elevated value of biomarker is related to pulmonary hypertension. CONCLUSIONS: Increased NT-proBNP/ULN is positively associated with larger LAD and LAA, while elevated NTproBNP is only associated with larger LAA. The highest levels of both NT-proBNP and NTproBNP/ULN were associated with HOCM and pulmonary hypertension, whereas biomarker levels were comparably lower in both the POHCM and NOHCM.
RESUMO
The aim of this study was to compare NT-proBNP using the absolute values and NT-proBNP/ULN values that were standardized by age and gender between three subgroups: those without ischemia (negative hs-troponin I and no anginal pain (hsTnI-/AP-)), those with painless ischemia (hsTnI+/AP-), and those with painful ischemia (hsTnI+/AP+). Additionally, echocardiographic parameters were compared in these three subgroups. The absolute value of NT-proBNP was significantly higher in the painful ischemia subgroup (hsTnI-/AP- vs. hsTnI+/AP- vs. hsTnI+/AP+: 502 (174-833) vs. 969 (363-1346) vs. 2053 (323-3283) pg/ml; p = 0.018 for the whole-model analysis). The standardized value of NT-proBNP/ULN was gradually increased (hsTnI-/AP- vs. hsTnI+/AP- vs. hsTnI+/AP+: 3.61 + 0.63 vs. 6.90 + 1.31 vs. 9.35 + 1.87; p = 0.001 for the whole-model analysis). In the comparison between subgroups (hsTnI-/AP- vs. hsTnI+/AP- vs. hsTnI+/AP+), two echocardiographic parameters increased significantly. The left ventricular maximum wall thickness (LVMWT) at diastole was 1.99 ± 0.08 cm vs. 2.28 ± 0.13 cm vs. 2.49 ± 0.15 cm (p = 0.004 for the whole-model analysis). The maximal gradient of the provoked left ventricular outflow tract (LVOT) gradient increased significantly in only the painful-ischemia subgroup (11 (7-30) mmHg vs. 12 (9.35-31.5) mmHg vs. 100 (43-120) mmHg). In conclusion, both painless ischemia and painful ischemia are associated with a gradual, significant increase in NT-proBNP/ULN in comparison to the double-negative hsTnI/AP subgroup. In contrast, NT-proBNP is significantly higher in only the subgroup with painful ischemia.
