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