所属 医学部 医学科（東京女子医科大学病院） 職種 講師
|発表タイトル||B-type Natriuretic Peptide and Outcome in Patients with Apical Hypertrophic Cardiomyopathy|
|発表者・共同発表者||◎城谷翔太, 南雄一郎, 齋藤千紘, 樋口諭, 鈴木敦, 志賀剛, 庄田守男, 萩原誠久|
|概要||*Poster Session (Japanese)118 Cardiomyopathy/Hypertrophy Clinical 2
Background: Although elevated B-type natriuretic peptide (BNP) levels predict mortality in patients with hypertrophic cardiomyopathy (HCM), the association between BNP levels and outcome in patients with apical phenotype of HCM (ApHCM) remains unclear. We thus evaluated the impact of elevated BNP levels on outcome in a relatively large and longitudinal cohort of ApHCM patients. Methods and Results: Among 432 HCM patients, 144 (33.3%) with an apical phenotype were examined. Plasma BNP levels were measured at initial evaluation. The median (interquartile range) BNP level in the study ApHCM patients was 188.5 (72.0-334.4) pg/mL. During a median (interquartile range) follow-up period of 9.5 (6.0-12.9) years, 34 patients (23.6%) experienced the combined clinical endpoint, including 2 patients (1.4%) with sudden death, 5 with appropriate implantable defibrillator shocks, 3 with stroke-related death, 8 with non-fatal stroke, and 16 with heart failure hospitalization. Receiver operating characteristic (ROC) curve analysis of the prognostic value of BNP for the combined endpoint showed that the area under the ROC curve was 0.756, and the optimal BNP cutoff point was 226.0 pg/mL (sensitivity 73.5%; specificity 68.2%; P<0.001). Patients with high BNP levels (226.0 pg/mL) were at significantly greater risk of the combined endpoint (log-rank P<0.001) than patients with low BNP levels (<226.0 pg/mL). Multivariable analysis that included BNP levels and potential confounders showed that high BNP levels were an independent determinant of the combined endpoint (adjusted hazard ratio: 4.46; 95% confidence interval: 2.07-9.61; P<0.001). Conclusions: Elevated BNP levels may be associated with combined clinical endpoints. Measuring BNP may help stratify the risk of adverse outcome in patients with ApHCM.