B-type natriuretic peptide and risk of sudden death in patients with hypertrophic cardiomyopathy

Heart Rhythm. 2018 Oct;15(10):1484-1490. doi: 10.1016/j.hrthm.2018.04.030. Epub 2018 Apr 28.


Background: The association between B-type natriuretic peptide (BNP) levels and sudden cardiac death in patients with hypertrophic cardiomyopathy (HCM) remains unclear.

Objective: This study evaluated the effect of elevated BNP levels on sudden death risk in a cohort of patients with HCM.

Methods: This study included 346 patients with HCM. Plasma BNP levels were measured at the initial evaluation.

Results: The median (interquartile range) BNP level in the study patients was 197.2 (84.4-353.3) pg/mL. During a median (interquartile range) follow-up period of 8.4 (4.2-12.5) years, 37 patients (10.7%) experienced the combined end point of sudden death or potentially lethal arrhythmic events, including 11 patients with sudden death (3.2%), 8 resuscitated after cardiac arrest, and 18 with appropriate implantable defibrillator shocks. Time-dependent receiver operating characteristic curve analysis of the prognostic value of BNP for the combined end point showed that the Harrell's concordance index was 0.748 and the optimal BNP cutoff point was 312 pg/mL. Patients with high BNP levels (>312 pg/mL) were at a significantly higher risk of sudden death (Gray test, P = .001) and the combined end point (Gray test, P < .001) than were patients with low BNP levels (≤312 pg/mL). Multivariable analysis that included BNP levels and established risk factors for sudden death showed that high BNP levels were an independent determinant of the combined end point (adjusted hazard ratio 5.71; 95% confidence interval 2.86-11.4; P < .001).

Conclusion: Elevated BNP levels may be associated with sudden death and the combination of sudden death or potentially lethal arrhythmic events in patients with HCM.

Keywords: B-type natriuretic peptide; Hypertrophic cardiomyopathy; Implantable defibrillator; Risk stratification; Sudden cardiac death.

MeSH terms

  • Biomarkers / blood
  • Cardiomyopathy, Hypertrophic / blood*
  • Cardiomyopathy, Hypertrophic / complications
  • Cardiomyopathy, Hypertrophic / mortality
  • Death, Sudden, Cardiac / epidemiology
  • Death, Sudden, Cardiac / etiology*
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Japan / epidemiology
  • Male
  • Middle Aged
  • Natriuretic Peptide, Brain / blood*
  • Prognosis
  • ROC Curve
  • Retrospective Studies
  • Risk Assessment / methods*
  • Risk Factors
  • Survival Rate / trends


  • Biomarkers
  • Natriuretic Peptide, Brain