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CLINICAL STUDY: HYPERTROPHIC CARDIOMYOPATHY

Increased plasma brain natriuretic peptide level as a guide for silent myocardial ischemia in patients with non-obstructive hypertrophic cardiomyopathy

Tomoki Nakamura, MD^*,*, Kenzo Sakamoto, MD, Tetsuhiro Yamano, MD, Masayuki Kikkawa, MD^*, Kan Zen, MD, Takato Hikosaka, MD, Takao Kubota, MD^*, Akihiro Azuma, MD, PhD and Tsunehiko Nishimura, MD, PhD^*

^* Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
Second Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan

Manuscript received August 2, 2001; revised manuscript received February 13, 2002, accepted February 19, 2002.

^* Reprint requests and correspondence: Dr. Tomoki Nakamura, Department of Radiology, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto 602-8566, Japan.
tomnak{at}koto.kpu-m.ac.jp

OBJECTIVES: We measured plasma atrial/brain natriuretic peptide (ANP/BNP) levels at rest and during exercise and correlated the results with various clinical findings, particularly with myocardial ischemia, in asymptomatic hypertrophic cardiomyopathy (HCM).

BACKGROUND: In patients with HCM, ANP and BNP levels are elevated and exercise-induced myocardial ischemia is common. However, it has not yet been elucidated how these levels at rest and their change with dynamic exercise are related to ischemia.

METHODS: Levels of ANP and BNP were measured at rest and at peak exercise during ^99mTc-tetrofosmin scintigraphy in 31 asymptomatic patients with non-obstructive HCM and in 10 control subjects.

RESULTS: Levels of ANP and BNP at rest and the change of ANP and BNP levels (pg/ml) from rest to exercise were significantly greater in HCM than in control subjects (ANP: rest, 53.2 ± 31.8 vs. 11.6 ± 6.1; exercise, 114.5 ± 74.8 vs. 28.3 ± 23.4. BNP: rest, 156.7 ± 104.1 vs. 9.8 ± 9.6; exercise, 201.6 ± 131.5 vs. 13.2 ± 14.5). Septal perforator compression (SPC) and exercise-induced ischemia were observed, respectively, in 20 (64.5%) and in 19 (61.3%) patients with HCM. The increment of ANP during exercise was similar between HCM subgroups with or without inducible ischemia. However, BNP levels at rest and BNP increments during exercise were significantly greater in the HCM subgroup with inducible ischemia than in the subgroup without (rest, 190.5 ± 116.2 vs. 103.1 ± 48.3; exercise, 250.5 ± 142.2 vs. 124.2 ± 58.6). Multiple logistic regression analysis revealed that SPC and BNP levels at rest were independently associated with exercise-induced ischemia.

CONCLUSIONS: Measurement of plasma BNP levels at rest may be useful in predicting silent myocardial ischemia in HCM.

Abbreviations and Acronyms   ANP   atrial natriuretic peptide   BNP   brain natriuretic peptide   HCM   hypertrophic cardiomyopathy   IRT   isovolumetric relaxation time   LV   left ventricular/ventricle   LVCD   left ventricular cavity dilation   LVEDP   left ventricular end-diastolic pressure   sBP   increase of systolic blood pressure   SPC   septal perforator compression   SPECT   single photon emission computed tomography or tomographic   TDI   transient dilation index

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