%0 Journal Article %A Guixin Wu %A Jie Liu %A Shuiyun Wang %A Shiqin Yu %A Ce Zhang %A Dong Wang %A Mo Zhang %A Yaoyao Yang %A Lianming Kang %A Shihua Zhao %A Rutai Hui %A Yubao Zou %A Jizheng Wang %A Lei Song %T N-terminal pro-brain natriuretic peptide and sudden cardiac death in hypertrophic cardiomyopathy %D 2021 %R 10.1136/heartjnl-2020-317701 %J Heart %P 1576-1583 %V 107 %N 19 %X 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.Data are available upon reasonable request. %U https://heart.bmj.com/content/heartjnl/107/19/1576.full.pdf