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Original research
Mid-regional proatrial natriuretic peptide for predicting prognosis in hypertrophic cardiomyopathy
  1. Céline Bégué1,
  2. Stellan Mörner2,
  3. Dulce Brito3,
  4. Christian Hengstenberg4,
  5. John G F Cleland5,6,
  6. Eloisa Arbustini7,
  7. Enrique Galve8,
  8. Thomas Wichter9,
  9. Anette Richter10,
  10. Jean-Louis Golmard11,
  11. Maguy Bernard12,
  12. Olivier Dubourg13,
  13. Michel Komajda14,
  14. Philippe Charron15,
  15. Richard Isnard16
  1. 1 Département de Cardiologie, Hopital Pitié-Salpêtrière, APHP, Paris, France
  2. 2 Heart Centre and Department of Public Health and Clinical Medicine, Umea University, Umea, Sweden
  3. 3 Hospital de Santa Maria, Lisbon School of Medicine, Lisbon, Portugal
  4. 4 Cardiology, Medical University of Vienna, Vienna, Austria
  5. 5 Robertson Institute of Biostatistics and Clinical Trials Unit, University of Glasgow, UK
  6. 6 Royal Brompton and Harefield Hospitals, Imperial College, London, UK
  7. 7 Centre for Inherited Cardiovascular Diseases, IRCCS Foundation, University Hospital Policlinico San Matteo, Pavia, Italy
  8. 8 Cardiovascular Department, Hospital Universitario Valle Hebrón, Barcelona, Spain
  9. 9 Niels-Stensen-Kliniken, Marienhospital, Heart Center Osnabrück–Bad Rothenfelde, Osnabrück, Germany
  10. 10 Klinik für Innere Medizin Kardiologie, Universitätskilinikum Gießen and Marburg, Marburg, Germany
  11. 11 Department of Biostatistics and Medical Information, Sorbonne University, AP-HP, Hopital Pitié-Salpêtrière, Paris, France
  12. 12 Biochemistry, Hopital Pitié-Salpêtrière, AP/HP, Paris, France
  13. 13 Cardiology, Ambroise Paré Hospital, Versailles-Saint Quentin University, Boulogne, France
  14. 14 Cardiology, Hopital Saint Joseph, Paris, France
  15. 15 Cardiology and Genetics, Pitié-Salpêtrière Hospital, IHU-ICAN, UMR-S 1166, AP-HP, Sorbonne Université, Paris, France
  16. 16 Département de Cardiologie, Sorbonne Université, AP-HP, Hôpital Pitié-Salpêtrière, Institute of Cardiometabolism and Nutrition (ICAN), ACTION Study Group, INSERM UMRS 1166, Paris 75013, France
  1. Correspondence to Professor Richard Isnard, Cardiology, Sorbonne Université, Institut de Cardiologie (AP-HP), Centre Hospitalier Universitaire Pitié-Salpêtrière, Institute of Cardiometabolism and Nutrition (ICAN), ACTION Study Group, INSERM UMRS 1166, Paris 75013, France; richard.isnard{at}


Objectives N-terminal probrain natriuretic peptide (NT-proBNP) predicts mortality and the development of heart failure in hypertrophic cardiomyopathy (HCM). Mid-regional proatrial natriuretic peptide (MR-proANP) is a stable by-product of production of atrial natriuretic peptide. We sought to compare the prognostic value of MR-proANP and NT-proBNP in HCM.

Methods We prospectively enrolled a cohort of patients with HCM from different European centres and followed them. All patients had clinical, ECG and echocardiographic evaluation and measurement of MR-proANP and NT-proBNP at inclusion.

Results Of 357 patients enrolled, the median age was 52 (IQR: 36–65) years. MR-proANP and NT-proBNP were both independently associated with age, weight, New York Heart Association (NYHA) class, left ventricular ejection fraction (LVEF), wall thickness and left atrial dimension. During a median follow-up of 23 months, 32 patients had a primary end point defined as death (n=6), heart transplantation (n=8), left ventricular assist device implantation (n=1) or heart failure hospitalisation (n=17). Both NT-proBNP and MR-proANP (p<10–4) were strongly associated with the primary endpoint, and the areas under the receiver operating characteristic (ROC) curves for both peptides were not significantly different. However, in a multiple stepwise regression analysis, the best model for predicting outcome was NYHA 1–2 vs 3–4 (HR=0.35, 95% CI 0.16 to 0.77, p<0.01), LVEF (HR=0.96, 95% CI 0.94 to 0.98, p=0.0005) and MR-proANP (HR=3.77, 95% CI 2.01 to 7.08, p<0.0001).

Conclusions MR-proANP emerges as a valuable biomarker for the prediction of death and heart failure related events in patients with HCM.

  • natriuretic peptide
  • MR-proANP
  • NT-proBNP
  • hypertrophic cardiomyopathy

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  • Contributors CB: analysis, writing, statistics. SM: design, collection of data, review. DB: design, collection of data, review. CH: collection of data, data management, review. JGFC: collection of data, writing, review. EA: design, collection of data, review. EG: collection of data, review. TW: collection of data, review. AR: collection of data, review. J-LG: statistics, writing. MB: collection of data. OD: collection of data, review. MK: design, review. PC: design, collection of data, review. RI: design, collection of data, analysis, writing.

  • Funding This work was supported by Fondation Leducq, Ligue contre la Cardiomyopathie and Fédération Française de Cardiologie.

  • Competing interests RI has received research grant and honoraria for speaking, committees and advisory boards from Novartis, Servier, Bayer, Pfizer, Amgen. JGFC has received research grant and honoraria for speaking, committees and advisory boards from Amgen, AstraZeneca, BMS, GSK, J&J, Medtronic, Myokardia, Novartis, Novartis, Philips, Pharmacosmos, PharmaNord, Sanofi, Servier, Stealth Biopharmaceuticals, Torrent Pharmaceuticals and Vifor. CH has received proctor fees, speaker honoraria and fees for advisory board from Edwards Lifesciences, Boston Scientific, AstraZeneca, Bayer, Biotronic, Boehringer Ingelheim, Novartis, Pfizer, BMS, Daiichi-Sankyo and Bayer. MK has received honoraria, consultancy fees or speaker bureau fees from Novartis, Servier, MSD, BMS, Amgen, Sanofi, Novo Nordisk.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

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