Relation between serum N-terminal pro-brain natriuretic peptide and prognosis in patients with hypertrophic cardiomyopathy

To determine the relation between serum concentrations of N-terminal pro-brain natriuretic peptide (NT-proBNP) and prognosis in patients with hypertrophic cardiomyopathy (HCM). In total, 847 patients (53 15 years; 67 male) with HCM (28 with left ventricular outflow tract obstruction 30 mmHg at rest) were followed for 3.5 years (IQR 2.54.5 years). The median NT-proBNP concentration was 78 pmol/L (range 51817 pmol/L and IQR 31183 pmol/L). Sixty-eight patients (8) reached the primary endpoint of all-cause mortality or cardiac transplantation. NT-proBNP concentration predicted long-term survival from the primary endpoint [area under the receiver operating characteristic curve of 0.78 (95 confidence interval 0.730.84)]. A serum concentration of 135 pmol/L was associated with an annual event rate of 6.1 (95 CI 4.47.7). Three independent predictors of primary outcome were identified in a multivariable Cox model: New York Heart Association class III/IV (HR 2.10, 95 CI 1.213.65, P 0.008), ejection fraction (HR 0.98, 95 CI 0.961.00, P 0.035), log NT-proBNP (HR 2.04, 95 CI 1.562.66, P 0.001). Log NT-proBNP was a significant predictor of heart failure (HF) and transplant-related deaths (n 23; HR 3.03, 95 CI 1.994.60, P 0.001) but not sudden death or appropriate implantable cardioverter defibrillator shock (n 11; HR 1.54, 95 CI 0.912.60, P 0.111). In patients with ejection fraction 50 (n 673), log NT-proBNP remained an independent predictor of the primary outcome (HR 2.11, 95 CI 1.542.90, P 0.001). In patients with HCM, elevated NT-proBNP concentration is a strong predictor of overall prognosis, particularly HF-related death and transplantation.