Abstract
The aim of this study was to compare NT-proBNP using the absolute values and NT-proBNP/ULN values that were standardized by age and gender between three subgroups: those without ischemia (negative hs-troponin I and no anginal pain (hsTnI-/AP-)), those with painless ischemia (hsTnI+/AP-), and those with painful ischemia (hsTnI+/AP+). Additionally, echocardiographic parameters were compared in these three subgroups. The absolute value of NT-proBNP was significantly higher in the painful ischemia subgroup (hsTnI-/AP- vs. hsTnI+/AP- vs. hsTnI+/AP+: 502 (174-833) vs. 969 (363-1346) vs. 2053 (323-3283) pg/ml; p = 0.018 for the whole-model analysis). The standardized value of NT-proBNP/ULN was gradually increased (hsTnI-/AP- vs. hsTnI+/AP- vs. hsTnI+/AP+: 3.61 + 0.63 vs. 6.90 + 1.31 vs. 9.35 + 1.87; p = 0.001 for the whole-model analysis). In the comparison between subgroups (hsTnI-/AP- vs. hsTnI+/AP- vs. hsTnI+/AP+), two echocardiographic parameters increased significantly. The left ventricular maximum wall thickness (LVMWT) at diastole was 1.99 ± 0.08 cm vs. 2.28 ± 0.13 cm vs. 2.49 ± 0.15 cm (p = 0.004 for the whole-model analysis). The maximal gradient of the provoked left ventricular outflow tract (LVOT) gradient increased significantly in only the painful-ischemia subgroup (11 (7-30) mmHg vs. 12 (9.35-31.5) mmHg vs. 100 (43-120) mmHg). In conclusion, both painless ischemia and painful ischemia are associated with a gradual, significant increase in NT-proBNP/ULN in comparison to the double-negative hsTnI/AP subgroup. In contrast, NT-proBNP is significantly higher in only the subgroup with painful ischemia.
Highlights
It is proposed [1, 2] that routine measurement biomarkers especially including [1] both N-terminal pro-B-type NTpronatriuretic peptide (NT-proBNP) and cardiac troponin (Tn) may be useful in the clinical evaluation and management of patients with HCM
There is little information about the combined use of Tn and plasma BNP as prognostic biomarkers for adverse events mediated by myocardial ischemia with left ventricular (LV) dysfunction [3]
Taking into account methodological aspects, we compared NT-proBNP using absolute values and NT-proBNP/ULN values that were standardized by age and gender between three subgroups: those without ischemia (negative hs-troponin I/no anginal pain), those with painless ischemia, and those with painful ischemia
Summary
It is proposed [1, 2] that routine measurement biomarkers especially including [1] both N-terminal pro-B-type NTpronatriuretic peptide (NT-proBNP) and cardiac troponin (Tn) may be useful in the clinical evaluation and management of patients with HCM. There is little information about the combined use of Tn and plasma BNP as prognostic biomarkers for adverse events mediated by myocardial ischemia with LV dysfunction [3]. In a study by Kubo et al [3] on 167 patients with HCM, TnI and BNP were measured only once at the initial examination without control measurements during a follow-up period of more than 3 years (mean value). The risk of adverse events was higher in patients with high BNP (≥200 pg/ml). TnI used in combination with BNP further improved the prognostic value, as patients with high values of both cTnI and BNP had nearly 12 times higher risk of cardiovascular events than patients with a combination of low cTnI/BNP values. This study had some important limitations because there was a long time between the initial biomarker measurement and the final event
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