Clinical utility of natriuretic peptides and troponins in hypertrophic cardiomyopathy

Kehl, Devin W.; Buttan, Anshu; Siegel, Robert J.; Rader, Florian

doi:10.1016/j.ijcard.2016.05.031

Cited by 21 publications

(26 citation statements)

References 45 publications

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“…In this context, it has recently been hypothesized that biomarkers, and hs-cTnT in particular, may be used as a "gateway" to perform LGE CMR imaging. 7,8 A strategy based on easily obtainable characteristics that would alter the pretest likelihood of extensive LGE before CMR imaging would increase efficacious use of LGE CMR imaging for SCD risk stratification in HC. 7,8 This may especially be valuable for institutions with limited resources to perform CMR imaging.…”

Section: Discussionmentioning

confidence: 99%

“…As such, these data should be appreciated as the first evidence that corroborates with the previously suggested hypothesis that hs-cTnT may be used as a gateway to perform LGE CMR imaging. 7,8 Importantly, this example is intended to demonstrate potential future implications and is not meant to be implemented in clinical practice. Many institutions have adopted CMR imaging in their standard initial workup for patients with suspected HC, as CMR imaging may aid in the identification of hypertrophy that goes unnoticed on echocardiography.…”

Section: Discussionmentioning

confidence: 99%

“…5 As extensive LGE (15% of left ventricular [LV] mass) is only seen in about 10%, 6 a strategy based on easily obtainable characteristics that would alter the pretest likelihood, would be a more cost-effective approach than routine LGE cardiovascular magnetic resonance (CMR) imaging. 7,8 In addition to various clinical variables (e.g., LV mass, wall thickness, and nonsustained ventricular tachycardia [NSVT] 9À11 ) biomarkers like cardiac troponin, natriuretic peptides, and markers of collagen turnover have repeatedly been associated with LGE in HC. 12À19 In the previously mentioned clinical context, we aimed to identify predictors of extensive LGE between routinely assessed clinical variables and a broad panel of biomarkers in nonhigh risk HC patients.…”

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confidence: 99%

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Prediction of Extensive Myocardial Fibrosis in Nonhigh Risk Patients With Hypertrophic Cardiomyopathy

Gommans

Cramer

Fouraux

et al. 2018

The American Journal of Cardiology

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In nonhigh risk patients with hypertrophic cardiomyopathy (HC), the presence of extensive late gadolinium enhancement (LGE) at cardiovascular magnetic resonance (CMR) imaging has been proposed as a risk modifier in the decision process for implantable cardioverter defibrillator implantation. With a pretest risk of about 10%, a strategy that alters the likelihood of LGE could markedly affect efficacious CMR imaging. Our aim was to study the potential of clinical variables and biomarkers to predict LGE. In 98 HC patients without any clear indication for implantable cardioverter defibrillator implantation, we determined the discriminative values of a set of clinical variables and a panel of biomarkers (hs-cTnT, NTproBNP, GDF-15, and Gal-3, CICP) for LGE, that is, LGE ≥15% of the left ventricular mass. LGE was present in 10% (10/98) of patients. The clinical prediction model contained a history of nonsustained ventricular tachycardia, maximal wall thickness and reduced systolic function (c-statistic: 0.868, p <0.001). Of all biomarkers, only hs-cTnT was associated with LGE, in addition to the improved clinical model of diagnostic accuracy (p = 0.04). A biomarker-only strategy allowed the exclusion of LGE in half of the cohort, in case of a hs-cTnT concentration less than the optimal cutoff (Youden index; 8 ng/L-sensitivity 100%, specificity 54%). In conclusion, in this nonhigh risk HC cohort, the pretest likelihood of LGE can be altered using clinical variables and the addition of hs-cTnT. The promising findings with the use of hs-cTnT only call for new initiatives to study its impact on efficacious CMR imaging in a larger HC population, either with or without additional use of clinical variables.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Prediction of Extensive Myocardial Fibrosis in Nonhigh Risk Patients With Hypertrophic Cardiomyopathy

Gommans

Cramer

Fouraux

et al. 2018

The American Journal of Cardiology

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“…43,52 Combining measurement of cardiac troponins with natriuretic peptides may provide additional value in assessing prognosis of several cardiomyopathies. In HCM, Brain natriuretic peptide (BNP) or N-terminal pro-brain natriuretic peptide (NT-proBNP) correlates with similar clinical parameters to Tn, 44,46,48,51,53 but was superior to hs-TnT at predicting which unaffected gene mutation carriers would go on to develop HCM. 54 To date there are few biomarker studies in pre-phenotypic disease in any cardiomyopathy.…”

Section: Familial Cardiomyopathy Tnnt2 Tnni3 Tnnc1mentioning

confidence: 99%

Measurement of Troponin in Cardiomyopathies

2016

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Troponins are thin myofilament proteins that regulate the contraction of cardiac and skeletal muscle. The cardio-specific troponin I (TnI) and T (TnT) proteins are sensitive and specific biomarkers of myocardial injury which over the past twenty years have revolutionised the diagnosis and management of myocardial infarction. With the advent of high sensitivity assays the role for cardiac troponins is possibly expanding. Elevated levels are associated with adverse cardiovascular events and mortality in heart failure and the general population. Studies in cardiomyopathies are generally small with <200 patients, but serum troponin levels can be chronically raised and detect subclinical myocyte damage. This review examines all major published studies of cardiac troponin measurement in cardiomyopathies. There is considerable variability among studies regarding assays used and definitions of abnormal results but elevated troponin levels are almost invariably related to poor prognosis and their negative predictive value is important.

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“…In hypertrophic cardiomyopathy (HCM), left atrial (LA) enlargement might be associated with cardiovascular death via the following mechanisms: as a risk factor for sudden car-diac death (SCD) due to ventricular fibrillation or as a cause of cardioembolic stroke due to atrial fibrillation (AF) [1,2].…”

Section: Introductionmentioning

confidence: 99%

Serum N-terminal pro-B-type natriuretic peptide levels are associated with left atrial dilation, resting left ventricular outflow tract gradient, and pulmonary hypertension in patients with hypertrophic cardiomyopathy

Gębka¹,

Rajtar-Salwa²,

Dziewierz³

et al. 2020

pwki

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Introduction: N-terminal pro-B-type natriuretic peptide (NT-proBNP) can be a marker of left ventricle (LV) pressure overload in hypertrophic cardiomyopathy (HCM). The different clinical characteristics of HCM might correspond to the degree of NT-proBNP increase. Aim: This study aimed to establish whether the left atrium (LA) dimension, left ventricle outflow tract (LVOT) gradient, and pulmonary hypertension influence NT-proBNP serum levels in patients with HCM. Material and methods: In 62 HCM patients (32 males and 30 females, mean age 31 ±11 years), echocardiography with LV outflow tract gradient provocation was performed using natural stimuli > 30 mm Hg (NOHCM-36 patients, POHCM-12 patients, HOCM-14 patients). Results: Smaller LAD was associated with a lower NT-proBNP/ULN level (p = 0.001). In contrast, smaller vs. larger LAD subgroups did not differ in NT-proBNP level (p = 0.42). Both NT-proBNP/ULN and NTproBNP were significantly elevated in the subgroup with lager LAA. The absolute value of NT-proBNP was significantly higher in the HOCM subgroup (NOHCM vs. POHCM vs. HOCM (p = 0.02). Similarly, NT-proBNP/ULN was significantly higher in the HOCM subgroup (NOHCM vs. POHCM vs. HOCM, p = 0.00047). This elevated value of biomarker is related to pulmonary hypertension. Conclusions: Increased NT-proBNP/ULN is positively associated with larger LAD and LAA, while elevated NTproBNP is only associated with larger LAA. The highest levels of both NT-proBNP and NTproBNP/ULN were associated with HOCM and pulmonary hypertension, whereas biomarker levels were comparably lower in both the POHCM and NOHCM.

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Clinical utility of natriuretic peptides and troponins in hypertrophic cardiomyopathy

Cited by 21 publications

References 45 publications

Prediction of Extensive Myocardial Fibrosis in Nonhigh Risk Patients With Hypertrophic Cardiomyopathy

Prediction of Extensive Myocardial Fibrosis in Nonhigh Risk Patients With Hypertrophic Cardiomyopathy

Measurement of Troponin in Cardiomyopathies

Serum N-terminal pro-B-type natriuretic peptide levels are associated with left atrial dilation, resting left ventricular outflow tract gradient, and pulmonary hypertension in patients with hypertrophic cardiomyopathy

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