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Degree and distribution of left ventricular hypertrophy as a determining factor for elevated natriuretic peptide levels in patients with hypertrophic cardiomyopathy: insights from cardiac magnetic resonance imaging

  • Jeong Rang Park
  • Jin-Oh Choi
  • Hye Jin Han
  • Sung-A Chang
  • Sung-Ji Park
  • Sang-Chol Lee
  • Yeon Hyeon Choe
  • Seung Woo Park
  • Jae K. Oh
Original Paper

Abstract

Whether the left ventricular (LV) mass index (LVMI) and LV volumetric parameters are associated independently with natriuretic peptide levels is unclear in hypertrophic cardiomyopathy (HCM). Therefore, we investigated which parameters have an independent relationship with N-terminal pro-B type natriuretic peptide (NT-proBNP) levels in HCM patients using echocardiography and cardiac magnetic resonance imaging (CMR). A total of 103 patients with HCM (82 men, age 53 ± 12 years) were evaluated. Echocardiographic evaluations included left atrial volume index (LAVI) and early diastolic mitral inflow E velocity to early annular Ea velocity ratio (E/Ea). LVMI, maximal wall thickness and LV volumetric parameters were measured using CMR. The median value of NT-proBNP level was 387.0 pg/ml. The mean NT-proBNP level in patients with non-apical HCM (n = 69; 36 patients with asymmetric septal hypertrophy, 11 with diffuse, and 22 with mixed type) was significantly higher than in those with apical HCM (n = 34, P < 0.001). NT-proBNP level was negatively correlated with LV end-diastolic volume (LVEDV) (r = −0.263, P = 0.007) and positively with LVMI (r = 0.225, P = 0.022) and maximal wall thickness (r = 0.495, P < 0.001). Among the echocardiographic variables, LAVI (r = 0.492, P < 0.001) and E/Ea (r = 0.432, P < 0.001) were correlated with NT-proBNP. On multivariable analysis, non-apical HCM, increased maximal wall thickness and LAVI were independently related with NT-proBNP. Severity of LV hypertrophy and diastolic parameters might be important in the elevation of NT-proBNP level in HCM. Therefore, further evaluation of these parameters in HCM might be warranted.

Keywords

Hypertrophic cardiomyopathy N-terminal pro B-type natriuretic peptide Cardiac magnetic resonance imaging 

Notes

Acknowledgments

This study was supported by a grant of the Korea Healthcare technology R&D Project, Ministry for Health, Welfare & Family Affairs, Republic of Korea (A085046).

Conflict of interest

None.

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Copyright information

© Springer Science+Business Media, B.V. 2011

Authors and Affiliations

  • Jeong Rang Park
    • 1
    • 2
    • 5
  • Jin-Oh Choi
    • 1
    • 2
  • Hye Jin Han
    • 1
    • 2
  • Sung-A Chang
    • 1
    • 2
  • Sung-Ji Park
    • 1
    • 2
  • Sang-Chol Lee
    • 1
    • 2
  • Yeon Hyeon Choe
    • 2
    • 3
  • Seung Woo Park
    • 1
    • 2
  • Jae K. Oh
    • 1
    • 2
    • 4
  1. 1.Division of Cardiology, Department of Medicine, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
  2. 2.Cardiovascular Imaging Center, Cardiac and Vascular Center, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
  3. 3.Department of Radiology and Center of Imaging Science, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
  4. 4.Division of Cardiovascular DiseasesMayo Clinic College of MedicineRochesterUSA
  5. 5.Division of Cardiology, Department of Internal MedicineGyeongsang National University HospitalJinjuRepublic of Korea

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