Objective Elevated levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) are associated with heart failure-related death in hypertrophic cardiomyopathy (HCM), but the relationship between NT-proBNP level and sudden cardiac death (SCD) in HCM remains undefined.
Methods The study prospectively enrolled 977 unrelated patients with HCM with available NT-proBNP results who were prospectively enrolled and followed for 3.0±2.1 years. The Harrell’s C-statistic under the receiver operating characteristic curve was calculated to evaluate discrimination performance. A combination model was constructed by adding NT-proBNP tertiles to the HCM Risk-SCD model. The correlation between log NT-proBNP level and cardiac fibrosis as measured by late gadolinium enhancement (LGE) or Masson’s staining was analysed.
Results During follow-up, 29 patients had SCD. Increased log NT-proBNP levels were associated with an increased risk of SCD events (adjusted HR 22.27, 95% CI 10.93 to 65.63, p<0.001). The C-statistic of NT-proBNP in predicting SCD events was 0.80 (p<0.001). The combined model significantly improved the predictive efficiency of the HCM Risk-SCD model from 0.72 to 0.81 (p<0.05), with a relative integrated discrimination improvement of 0.002 (p<0.001) and net reclassification improvement of 0.67 (p<0.001). Furthermore, log NT-proBNP levels were significantly correlated with cardiac fibrosis as detected either by LGE (r=0.257, p<0.001) or by Masson’s trichrome staining in the myocardium (r=0.198, p<0.05).
Conclusion NT-proBNP is an independent predictor of SCD in patients with HCM and may help with risk stratification of this disease.
- cardiac risk factors and prevention
- hypertrophic cardiomyopathy
- quality and outcomes of care
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GW, JL and SW contributed equally.
Contributors YZ, JW and LS designed the study. JW and LS supervised the study. GW, SW, JL, SY, CZ, CZ, DW, MZ, YY, LK, SZ and RH performed sample acquisition and data collection. GW and JL performed data analysis. GW, YZ, JW and LS interpreted the results of analysis. GW, JW and LS wrote the manuscript. All authors read and contributed to the manuscript.
Funding This work was supported by CAMS Innovation Fund for Medical Sciences (CAMS-I2M, 2016-I2M-1–015) and the National Natural Science Foundation of China (81870286, 81670274, 81470380 and 81570276).
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval Study protocols were approved by the Ethics Committee of Fuwai Hospital and conformed to the principles of the Declaration of Helsinki.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request.
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