Mid-regional proatrial natriuretic peptide for predicting prognosis in hypertrophic cardiomyopathy

Céline Bégué, Stellan Mörner, Dulce Brito, Christian Hengstenberg, John G.F. Cleland, Eloisa Arbustini, Enrique Galve, Thomas Wichter, Anette Richter, Jean Louis Golmard, Maguy Bernard, Olivier Dubourg, Michel Komajda, Philippe Charron, Richard Isnard

Research output: Contribution to journalArticlepeer-review


OBJECTIVES: N-terminal probrain natriuretic peptide (NT-proBNP) predicts mortality and the development of heart failure in hypertrophic cardiomyopathy (HCM). Mid-regional proatrial natriuretic peptide (MR-proANP) is a stable by-product of production of atrial natriuretic peptide. We sought to compare the prognostic value of MR-proANP and NT-proBNP in HCM. METHODS: We prospectively enrolled a cohort of patients with HCM from different European centres and followed them. All patients had clinical, ECG and echocardiographic evaluation and measurement of MR-proANP and NT-proBNP at inclusion. RESULTS: Of 357 patients enrolled, the median age was 52 (IQR: 36-65) years. MR-proANP and NT-proBNP were both independently associated with age, weight, New York Heart Association (NYHA) class, left ventricular ejection fraction (LVEF), wall thickness and left atrial dimension. During a median follow-up of 23 months, 32 patients had a primary end point defined as death (n=6), heart transplantation (n=8), left ventricular assist device implantation (n=1) or heart failure hospitalisation (n=17). Both NT-proBNP and MR-proANP (p<10-4) were strongly associated with the primary endpoint, and the areas under the receiver operating characteristic (ROC) curves for both peptides were not significantly different. However, in a multiple stepwise regression analysis, the best model for predicting outcome was NYHA 1-2 vs 3-4 (HR=0.35, 95% CI 0.16 to 0.77, p<0.01), LVEF (HR=0.96, 95% CI 0.94 to 0.98, p=0.0005) and MR-proANP (HR=3.77, 95% CI 2.01 to 7.08, p<0.0001). CONCLUSIONS: MR-proANP emerges as a valuable biomarker for the prediction of death and heart failure related events in patients with HCM.

Original languageEnglish
Pages (from-to)196-202
Number of pages7
JournalHeart (British Cardiac Society)
Issue number3
Publication statusPublished - Feb 1 2020


  • hypertrophic cardiomyopathy
  • MR-proANP
  • natriuretic peptide
  • NT-proBNP

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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