Abstract
Background: N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) is increased in patients with hypertrophic cardiomyopathy (HCM); however, the determinants of NT‐proBNP level have not been clarified in HCM.
Hypothesis: This study was performed to determine the relationship between NT‐proBNP levels and various echocardiographic variables of patients with HCM and normal left ventricular ejection fraction (LVEF).
Methods: We assessed plasma NT‐proBNP levels and echocardiographic variables of 36 patients (19 men, 58 ± 14 years) with HCM and an LVEF of ≥ 55%. Echocardiographic variables measured were LV wall thickness, end‐diastolic LV internal dimension (LVIDd) and volume (LVEDV), LV mass, and LV mass index (LV mass/body surface area, LVMI). Left ventricular outflow tract pressure gradient, transmitral E and A velocities, deceleration time (DT) of the transmitral E wave, and septal annular E' velocity were measured by Doppler technique. The relationship between echocardiographic variables and plasma NT‐proBNP level was analyzed.
Results: The plasma NT‐proBNP level was 775.2 ± 994.2 pg/ml (range 33.1‐729.0 pg/ml). It showed positive correlations with LV end‐diastolic septal thickness (r = 0.39, p = 0.010) and LVMI (r = 0.27, p = 0.050), while it revealed negative correlations with LVIDd (r = −0.44, p = 0.004), LVEDV (r= −0.44, p = 0.004) and DT(r= −0.31, p = 0.034). The NT‐proBNP level was higher in the patients with than in those without LV diastolic dysfunction (p = 0.03 3) and was independently related to LVIDd (p = 0.001), LVMI (p = 0.006) and DT (p = 0.031) by multivariate analysis.
Conclusion: In patients with HCM and normal LVEF, the amount of LV hypertrophy and LV diastolic dysfunction may exert a significant role in determining plasma NT‐proBNP level.
Keywords: hypertrophic cardiomyopathy, natriuretic peptide, hypertrophy, diastolic dysfunction
Full Text
The Full Text of this article is available as a PDF (54.5 KB).
References
- 1. Mizuno Y, Yoshimura M, Harada E, Nakayama M, Sakamoto T, Shimasaki Y, Ogawa H, Kugiyama K, Saito Y, Nakao K, Yasue H: Plasma levels of A‐and B‐type natriuretic peptides in patients with hypertrophic cardiomyopathy or idiopathic dilated cardiomyopathy. Am J Cardiol 2000; 86: 1036–1040, A1011 [DOI] [PubMed] [Google Scholar]
- 2. Paulus WJ: Natriuretic peptides to probe haemodynamic overload in hypertrophic cardiomyopathy. Eur Heart J 2001; 22: 1249–1251 [DOI] [PubMed] [Google Scholar]
- 3. Hall C: Essential biochemistry and physiology of (NT‐pro)BNP. Eur J Heart Fail 2004; 6: 257–260 [DOI] [PubMed] [Google Scholar]
- 4. Morrow DA, Braunwald E: Future of biomarkers in acute coronary syndromes: Moving toward a multimarker strategy. Circulation 2003; 108: 250–252 [DOI] [PubMed] [Google Scholar]
- 5. Kinnunen P, Vuolteenaho O, Ruskoaho H: Mechanisms of atrial and brain natriuretic peptide release from rat ventricular myocardium: Effect of stretching. Endocrinology 1993; 132: 1961–1970 [DOI] [PubMed] [Google Scholar]
- 6. Hammerer‐Lercher A, Neubauer E, Muller S, Pachinger O, Puschendorf B, Mair J: Head‐to‐head comparison of N‐terminal pro‐brain natriuretic peptide, brain natriuretic peptide and N‐terminal pro‐atrial natriuretic peptide in diagnosing left ventricular dysfunction. Clin Chim Acta 2001; 310: 193–197 [DOI] [PubMed] [Google Scholar]
- 7. Nishigaki K, Tomita M, Kagawa K, Noda T, Minatoguchi S, Oda H, Wa‐tanabe S, Morita N, Nakao K, Fujiwara H, Fukuda N, Shinohara H, Sakabe K, Nada T, Tamura Y: Marked expression of plasma brain natriuretic peptide is a special feature of hypertrophic obstructive cardiomyopathy. Plasma levels of brain natriuretic peptide in various forms of obstruction to the left ventricular outflow tract. J Am Coll Cardiol 1996; 28: 1234–1242 [DOI] [PubMed] [Google Scholar]
- 8. Fahy GJ, McCreery CJ, O'Sullivan F, Keenan AK, Quigley PJ, Maurer BJ: Plasma atrial natriuretic peptide is elevated in patients with hypertrophic cardiomyopathy. Int J Cardiol 1996; 55: 149–155 [DOI] [PubMed] [Google Scholar]
- 9. Briguori C, Betocchi S, Manganelli F, Gigante B, Losi MA, Ciampi Q, Gottilla R, Violante A, Tocchetti CG, Volpe M, Chiariello M: Determinants and clinical significance of natriuretic peptides and hypertrophic cardiomyopathy. Eur Heart J 2001; 22: 1328–1336 [DOI] [PubMed] [Google Scholar]
- 10. Maron BJ, Tholakanahalli VN, Zenovich AG, Casey SA, Duprez D, Aeppli DM, Cohn JN: Usefulness of B‐type natriuretic peptide assay in the assessment of symptomatic state in hypertrophic cardiomyopathy. Circulation 2004; 109: 984–989 [DOI] [PubMed] [Google Scholar]
- 11. Maron BJ: Hypertrophic cardiomyopathy. Lancet 1997; 350: 127–133 [DOI] [PubMed] [Google Scholar]
- 12. Maron BJ, Epstein SE: Hypertrophic cardiomyopathy: A discussion of nomenclature. Am J Cardiol 1979; 43: 1242–1244 [DOI] [PubMed] [Google Scholar]
- 13. Ogino K, Ogura K, Kinugawa T, Osaki S, Kato M, Furuse Y, Kinugasa Y, Tomikura Y, Igawa O, Hisatome I, Shigemasa C: Neurohumoral profiles in patients with hypertrophic cardiomyopathy: Differences to hypertensive left ventricular hypertrophy. Circ J 2004; 68: 444–450 [DOI] [PubMed] [Google Scholar]
- 14. Teichholz LE, Kreulen T, Herman MV, Gorlin R: Problems in echocardio‐graphic volume determinations: Echocardiographic‐angiographic correlations in the presence or absence of asynergy. Am J Cardiol 1976; 37: 7–11 [DOI] [PubMed] [Google Scholar]
- 15. Devereux RB, Reichek N: Echocardiographic determination of left ventricular mass in man. Anatomic validation of the method. Circulation 1977; 55: 613–618 [DOI] [PubMed] [Google Scholar]
- 16. Loperfido F, Pennestri F, Digaetano A, Scabbia E, Santarelli P, Mongiardo R, Schiavoni G, Coppola E, Manzoli U: Assessment of left atrial dimensions by cross sectional echocardiography in patients with mitral valve disease. Br Heart J 1983; 50: 570–578 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17. Ommen SR: Echocardiographic assessment of diastolic function. Curr Opin Cardiol 2001; 16: 240–245 [DOI] [PubMed] [Google Scholar]
- 18. Redfield MM, Rodeheffer RJ, Jacobsen SJ, Mahoney DW, Bailey KR, Burnett JC Jr: Plasma brain natriuretic peptide concentration: Impact of age and gender. J Am Coll Cardiol 2002; 40: 976–982 [DOI] [PubMed] [Google Scholar]
- 19. Manganelli F, Betocchi S, Losi MA, Briguori C, Pace L, Ciampi Q, Perrone‐Filardi P, Salvatore M, Finizio F, Pezzella E, Chiariello M: Influence of left ventricular cavity size on clinical presentation in hypertrophic cardiomyopathy. Am J Cardiol 1999; 83: 547–552 [DOI] [PubMed] [Google Scholar]
- 20. Vanderheyden M, Goethals M, Verstreken S, De Bruyne B, Muller K, Van Schuerbeeck E, Bartunek J: Wall stress modulates brain natriuretic peptide production in pressure overload cardiomyopathy. J Am Coll Cardiol 2004; 44: 2349–2354 [DOI] [PubMed] [Google Scholar]
- 21. Maron BJ, Spirito P, Green KJ, Wesley YE, Bonow RO, Arce J: Noninvasive assessment of left ventricular diastolic function by pulsed Doppler echocardiography in patients with hypertrophic cardiomyopathy. J Am Coll Cardiol 1987; 10: 733–742 [DOI] [PubMed] [Google Scholar]
- 22. Spirito P, Maron BJ, Chiarella F, Bellotti P, Tramarin R, Pozzoli M, Vecchio C: Diastolic abnormalities in patients with hypertrophic cardiomyopathy: Relation to magnitude of left ventricular hypertrophy. Circulation 1985; 72: 310–316 [DOI] [PubMed] [Google Scholar]
- 23. Lubien E, DeMaria A, Krishnaswamy P, Clopton P, Koon J, Kazanegra R, Gardetto N, Wanner E, Maisel AS: Utility of B‐natriuretic peptide in detecting diastolic dysfunction: Comparison with Doppler velocity recordings. Circulation 2002; 105: 595–601 [DOI] [PubMed] [Google Scholar]
- 24. Kohno M, Horio T, Yokokawa K, Yasunari K, Ikeda M, Minami M, Kurihara N, Takeda T: Brain natriuretic peptide as a marker for hypertensive left ventricular hypertrophy: Changes during 1‐year antihypertensive therapy with angiotensin‐converting enzyme inhibitor. Am J Med 1995; 98: 257–265 [DOI] [PubMed] [Google Scholar]
- 25. Yoshimoto T, Naruse M, Tanabe A, Naruse K, Seki T, Imaki T, Muraki T, Matsuda Y, Demura H: Potentiation of natriuretic peptide action by the beta‐adrenergic blocker carvedilol in hypertensive rats: A new antihypertensive mechanism. Endocrinology 1998; 139: 81–88 [DOI] [PubMed] [Google Scholar]
- 26. Hirata Y, Matsumoto A, Aoyagi T, Yamaoki K, Komuro I, Suzuki T, Ashida T, Sugiyama T, Hada Y, Kuwajima I, Nishinaga M, Akioka H, Nakajima O, Nagai R, Yazaki Y: Measurement of plasma brain natriuretic peptide level as a guide for cardiac overload. Cardiovasc Res 2001; 51: 585–591 [DOI] [PubMed] [Google Scholar]