Archives of the Turkish Society of Cardiology
The role of plasma N-terminal pro B-type natriuretic peptide to predict the clinical course of patients with hypertrophic cardiomyopathy [Turk Kardiyol Dern Ars]
Turk Kardiyol Dern Ars. 2005; 33(2): 77-83

The role of plasma N-terminal pro B-type natriuretic peptide to predict the clinical course of patients with hypertrophic cardiomyopathy

Fatih Bayrak1, Gökhan Kahveci1, Hakan Fotbolcu1, Kürşat Tigen1, Bülent Mutlu1, Yelda Başaran1


OBJECTIVES
Little information exists concerning the role of natriuretic peptides in the prognosis of hypertrophic cardiomyopathy (HCM). In this study, we evaluated the value of N-terminal pro-brain natriuretic peptide (Nt-proBNP) in predicting clinical prognoses of patients with HCM.
STUDY DESIGN
On a prospective design, 61 consecutive patients (36 males, 25 females; mean age 47 years; range 13-74 years) were monitored following a diagnosis of HCM upon detection of hypertrophy of the left ventricle (at least 15 mm in thickness) by transthoracic echocardiography. Peripheral blood samples were obtained to determine Nt-proBNP levels. Functional capacity was classified according to the NYHA (New York Heart Association) system. The patients were monitored for adverse clinical events defined as cardiovascular death, syncope, or worsening of heart failure symptoms for a mean of 416 days (range 150-570 days). Independent prognostic factors of adverse clinical events were determined with the use of the univariate and stepwise multivariate Cox proportional hazard regression analysis. A receiver operating characteristic (ROC) curve was used to validate the predictive performance of log Nt-proBNP for adverse clinical events.
RESULTS
Adverse clinical events developed in 11 patients (18%). Mortality occurred in one patient. In the multivariate analysis, log Nt-proBNP was found to be the only predictor of adverse clinical events (p=0.002, %95 CI). With an area of ROC curve being 0.9, the best value of log Nt-proBNP with the highest sensitivity (87%) and specificity (88%) was 7.3, equivalent to a level of 1500 pg/ml. The Kaplan-Meier analysis showed a significantly higher event-free survival in patients having a Nt-proBNP level of less than 1500 pg/ml.
CONCLUSION
Plasma levels of Nt-proBNP seem to be a reliable and practical parameter that can be used in predicting the clinical course of patients with HCM.

Keywords: Biological markers/ blood; cardiomyopathy, hypertrophic/blood; echocardiography, Doppler; natriuretic peptide, brain/blood; ventricular dysfunction.

How to cite this article
Fatih Bayrak, Gökhan Kahveci, Hakan Fotbolcu, Kürşat Tigen, Bülent Mutlu, Yelda Başaran. The role of plasma N-terminal pro B-type natriuretic peptide to predict the clinical course of patients with hypertrophic cardiomyopathy. Turk Kardiyol Dern Ars. 2005; 33(2): 77-83
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