Abstract
The aim of study was to compare patients with hypertrophic cardiomyopathy divided according to septal configuration assessed in a 4-chamber apical window. The study group consisted of 56 consecutive patients. Reversed septal curvature (RSC) and non-RSC were diagnosed in 17 (30.4%) and 39 (69.6%) patients, respectively. Both RSC and non-RSC groups were compared in terms of the level of high-sensitivity troponin I (hs-TnI), NT-proBNP (absolute value), NT-proBNP/ULN (value normalized for sex and age), and echocardiographic parameters, including left ventricular outflow tract gradient (LVOTG). A higher level of hs-TnI was observed in RSC patients as compared to the non-RSC group (102 (29.2-214.7) vs. 8.7 (5.3-18) (ng/l), p = 0.001). A trend toward increased NT-proBNP value was reported in RSC patients (1279 (367.3-1186) vs. 551.7 (273-969) (pg/ml), p = 0.056). However, no difference in the NT-proBNP/ULN level between both groups was observed. Provocable LVOTG was higher in RSC as compared to non-RSC patients (51 (9.5-105) vs. 13.6 (7.5-31) (mmHg), p = 0.04). Furthermore, more patients with RSC had prognostically unfavourable increased septal thickness to left LV diameter at the end diastole ratio. Patients with RSC were associated with an increased level of hs-TnI, and the only trend observed in this group was for the higher NT-proBNP levels. RSC seems to be an alerting factor for the risk of ischemic events. Not resting but only provocable LVOTG was higher in RSC as compared to non-RSC patients.
Highlights
Monitoring of biomarkers including troponin (Tn) and Nterminal pro-B-type NT-pronatriuretic peptide (NT-proBNP) might be utilized in the clinical evaluation, management, and prognosis of patients with hypertrophic cardiomyopathy (HCM) [1]
A higher level of high-sensitivity troponin I (hs-TnI) was observed in reversed septal curvature (RSC) patients as compared to the nonreversed septal curvature (non-RSC) group
In transthoracic echocardiography (TTE) parameters, the RSC group was characterized by a higher value of provocable left ventricular outflow tract gradient (LVOTG) as compared to non-RSC patients; similar resting LVOT was observed
Summary
Monitoring of biomarkers including troponin (Tn) and Nterminal pro-B-type NT-pronatriuretic peptide (NT-proBNP) might be utilized in the clinical evaluation, management, and prognosis of patients with hypertrophic cardiomyopathy (HCM) [1]. Reported papers have studied the importance of very short time synchronization in the sampling of echocardiographic parameters and cardiac biomarkers in HCM [2, 3] The strategy of these studies was based on performing transthoracic echocardiography (TTE) and evaluation of hs-troponin I and NT-proBNP as close to each other as possible. Such tactic guarantees that currently detected ischemia is related to actual myocardial functional/dynamic status with provoked left ventricular outflow tract gradient (LVOTG) as an equivalent. A pathomorphological study revealed that RSC occurs more frequently in young than in elderly victims of sudden cardiac death (SCD) [6] This fact might suggest that majority of patients with RSC configuration died prematurely probably due to ischemia-provoked ventricular fibrillation. We sought to compare both RSC and non-RSC groups in terms of the biomarker level and echocardiographic parameters, including LVOTG
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