BNP predicts adverse events in apical hypertrophic cardiomyopathy

Elevated levels of B-type natriuretic peptide (BNP) may help predict the incidence of adverse events and related outcomes in patients with apical hypertrophic cardiomyopathy (HCM), a recent study has found.

The study included 144 patients with apical HCM, in whom the median BNP concentration was 188.5 pg/mL. Over 9.5 years of follow-up, 23.6 percent (n=34) of the cohort developed HCM-related adverse outcomes, such as sudden death, stroke-related death, non-fatal stroke, and heart failure hospitalization, among others.

The researchers saw that BNP levels at enrolment were significantly higher in patients who did vs did not develop the combined HCM endpoints (334.4 vs 133.4 pg/mL; p<0.001).

Receiver operating characteristic (ROC) curve analysis showed that at an optimal cutoff of ≥226.0 pg/mL, BNP was sufficiently indicative of the study endpoint, with an area under the ROC curve of 0.756, and sensitivity and specificity values of 73.5 percent and 68.2 percent, respectively.

Twenty-five patients with high BNP developed the combined endpoint over a median of 8.9 years, yielding a rate of 41.7 percent. Of these, there was one case of sudden death, four stroke-related deaths, seven non-fatal strokes, and 10 heart failure hospitalizations. In contrast, only nine episodes (10.7 percent) were reported in the low-BNP participants, over a longer follow-up period of 9.8 years.

Multivariable analysis confirmed that the risk for combined HCM-related adverse events was significantly elevated in patients with BNP >226.0 pg/mL (adjusted hazard ratio, 4.46, 95 percent confidence interval, 2.07–9.61; p<0.001).