Amount of left ventricular hypertrophy determines the plasma N‐terminal pro‐brain natriuretic peptide level in patients with hypertrophic cardiomyopathy and normal left ventricular ejection fraction

Abstract

SummaryBackground: N-terminal pro-brain natriuretic peptide (NTproBNP) 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 tech-

Degree and distribution of left ventricular hypertrophy as a determining factor for elevated natriuretic peptide levels in patients with hypertrophic cardiomyopathy: insights from cardiac magnetic resonance imaging

“…Magga et al showed that a large LVESV was associated with elevated NT-proBNP levels using CMR in 25 patients and suggested that unfavorable remodeling toward a dilated LV process might augment NT-proBNP levels [9]. However, in our results, elevated NT-proBNP levels were associated with small LVEDV, consistent with the results of Kim et al [7]. This conflict finding might be result from different patient's characteristics.…”

“…This conflict finding might be result from different patient's characteristics. Our study and the study of Kim et al [7] included patients with normal ejection fraction. Therefore, we think that the LV hypertrophy promotes the elevation of LV wall tension and secretion of natriuretic peptides from an early stage of progression of HCM.…”

“…These elevated levels are associated with symptoms of heart failure, dynamic obstruction of left ventricular (LV) outflow tract (LVOT), and systolic and diastolic LV dysfunction in previous studies [2][3][4][5][6]. In some reports using 2-dimensional echocardiography, the severity of LV hypertrophy such as maximal wall thickness and LV mass index (LVMI) was associated with the elevation of BNP levels [6,7]. However, echocardiographic evaluation has some limitations for the estimation of LVMI as it entails rough geometric assumptions, high interobserver variability and difficult endocardial border definition.…”

The Diagnostic Significance of the Plasma N-Terminal Pro-B-Type Natriuretic Peptide Concentration in Asymptomatic Cats with Cardiac Enlargement

“…Tables 1 and 2 show clinical profiles of both groups and current medication in the test group, respectively. In this study, cardiac enlargement was defined as a diastolic interventricular septum thickness (IVSd) and/or diastolic left ventricular posterior wall thickness (LVPWd) >0.6 cm, left atria/aorta ratio (LA/Ao) >1.5 on echocardiograms [11,13], and/or vertebra heart scale (VHS) >7.8 on right lateral thoracic X-ray images [15]. Echocardiography was performed in all cats under a conscious state.…”

“…In humans with HCM, the plasma NT-proBNP concentration has been reported to be significantly associated with the severity of heart failure, left atrial size, the degree of ventricular diastolic dysfunction and left ventricular hypertrophy, and pressure gradient between the aorta and left ventricle [1,11]. Furthermore, one human study reported that the plasma NT-proBNP concentration had high specificity for asymptomatic left ventricular dysfunction [2].…”