Increased brain natriuretic peptide secretion is a marker of disease progression in nonobstructive hypertrophic cardiomyopathy.
BACKGROUND
Hypertrophic cardiomyopathy (HCM) is associated with increased plasma brain natriuretic peptide (BNP), but sequential plasma and myocardial BNP assessment in stable and dilated HCM has never been performed.


RESULTS
Forty consecutive HCM patients (42 +/- 8 years, 25 males) underwent cardiac catheterization, angiography, and left ventricular (LV) endomyocardial biopsy. During follow-up (70.5 +/- 6.7 months), 30 patients (Group 1) remained stable whereas 10 patients (Group 2) progressed to dilated phase. Group 2 patients underwent a second invasive study with LV biopsy. BNP plasma levels were measured at baseline and at follow-up in all patients. All biopsies were processed for histology and immunohistochemistry with anti-BNP antibodies. BNP plasma levels remained unchanged in Group 1, whereas it significantly increased in all Group 2 patients who exhibited an elevation of LV and right ventricular end-diastolic pressure. Immunohistochemistry showed an increase of BNP-positive myocytes in follow-up biopsies when compared with baseline (75.0 +/- 15.0 % versus 29.8 +/- 10.0 %; P = .005) with a significant correlation with LV end-diastolic pressure (r = 0.78, P < .001) and plasma BNP (r = 0.83, P < .001).


CONCLUSIONS
Progression to end-stage of HCM is characterized by further increase of myocardial and plasma BNP. Serial assessment of plasma BNP may provide noninvasive recognition of hemodynamic deterioration, allowing prompt institution of heart failure therapy.
Pieroni
Maurizio
M
Cardiology Department, Catholic University, Rome, Italy.
Bellocci
Fulvio
F
Sanna
Tommaso
T
Verardo
Romina
R
Ierardi
Carolina
C
Maseri
Attilio
A
Frustaci
Andrea
A
Crea
Filippo
F
D000328:Adult; D002311:Cardiomyopathy, Dilated / Q000097:blood* / Q000000981:diagnostic imaging; D018450:Disease Progression; D005260:Female; D006352:Heart Ventricles / Q000737:chemistry; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000737:chemistry; D020097:Natriuretic Peptide, Brain / Q000097:blood / Q000378:metabolism*; D011379:Prognosis; D014463:Ultrasonography
D020097:Natriuretic Peptide, Brain