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Original research
N-terminal pro-brain natriuretic peptide and sudden cardiac death in hypertrophic cardiomyopathy
  1. Guixin Wu1,2,
  2. Jie Liu1,2,
  3. Shuiyun Wang3,
  4. Shiqin Yu4,
  5. Ce Zhang5,
  6. Dong Wang2,
  7. Mo Zhang2,
  8. Yaoyao Yang5,
  9. Lianming Kang2,
  10. Shihua Zhao4,
  11. Rutai Hui1,
  12. Yubao Zou5,
  13. Jizheng Wang1,
  14. Lei Song1,6
  1. 1State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
  2. 2Cardiomyopathy Ward, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
  3. 3Department of Cardiac Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
  4. 4Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
  5. 5Department of Cardiovascular Internal Medicine, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
  6. 6National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
  1. Correspondence to Jizheng Wang, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 10037, China; jzwang{at}hotmail.com; Dr Lei Song, Cardiomyopathy Ward, State Key Laboratory of Cardiovascular DiseaseNational Clinical Research Center of Cardiovascular DiseasesFuwai Hospital, National Center for Cardiovascular DiseaseChinese Academy of Medical Science and Peking Union Medical College, Beijing, China; songlqd{at}126.com; Dr Yubao Zou, Department of Cardiovascular Internal MedicineFuwai Hospital, National Center for Cardiovascular DiseaseChinese Academy of Medical Science and Peking Union Medical College, Beijing, China; zouyb1973{at}sina.com

Abstract

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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Footnotes

  • 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.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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