0316: Mid-regional pro-atrial natriuretic peptide for predicting mortality and morbidity in hypertrophic cardiomyopathy: a comparison with N-terminal pro-brain natriuretic peptide

详细信息    查看全文

• 作者：Cé ; line Bé ; gué ; ; ⁽¹⁾ ; ^{celinebegue85@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Enrique Galve⁽²⁾ ; Jean-Louis Golmard⁽²⁾ ; Stellan Morner⁽³⁾ ; Franç ; oise Bismut⁽³⁾ ; Dulce Brito⁽⁴⁾ ; Eloisa Arbustini⁽⁵⁾ ; Christian Hengstenberg⁽⁶⁾ ; Olivier Dubourg⁽⁷⁾ ; Philippe Charron⁽⁷⁾ ; Michel Komajda⁽⁷⁾ ; Richard Isnard⁽⁷⁾
• 刊名：Archives of Cardiovascular Diseases Supplements
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：8
• 期：1
• 页码：23
• 全文大小：198 K

文摘

HCM has a diverse clinical spectrum and prognostication can be challenging. N-terminal pro-brain natriuretic peptide (NTproBNP) has been recently proposed for predicting death in HCM. Mid-regional pro-atrial natriuretic peptide (MRproANP) is a stable natriuretic peptide reflecting increased atrial wall tension, with potential advantages over conventional natriuretic peptides.

Purpose

To determine the prognostic value of MRproANP in HCM compared with NTproBNP.

Methods

491 patients with HCM were prospectively enrolled from 11 European centres in the Eurogene Heart Failure study. All patients had clinical, ECG, echocardiographic evaluation and MRproANP and NTproBNP measurement. Follow-up was available for 356 patients.

Results

At baseline, log MRproANP and log NTproBNP were both independently associated with age, weight, NYHA class, left ventricular ejection fraction (LVEF), wall thickness (WT) and left atrial dimension (LA), but the association was stronger between LA and MRproANP than NTproBNP and stronger between WT and NTproBNP than MRproANP. During a median follow-up of 24 months, 29 patients (8%) had a primary end point defined as death, heart transplantation, left ventricular assist device (LVAD) and HF hospitalization. In univariate analysis, both log NTproBNP (p<0.0001) and log MRproANP (p<0.0001) were strongly associated with primary endpoint. However, in a multiple stepwise regression analysis, entering first clinical data, then echocardiography and then natriuretic peptides, the best model for predicting outcome was NYHA (HR=3.1, CI 95% [1.43-6.75], p=0.004), previous HF hospitalization (HR 2.49, CI 95% [1.09-5.69], p=0.03), LVEF (HR=0.70, CI 95% [0.55-0.88], p=0.003), and log MRproANP (HR=3.27, CI 95% [1.78-6.09], p<0,0002).

Conclusions

In this large cohort of HCM patients, MRproANP outperformed NTproBNP in the prediction of the combined event cardiac death/ transplantation/LVAD and hospitalization for heart failure.