What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Hypertrophic cardiomyopathy with preserved ejection fraction (n=119). Intervention: Nt-proBNP and maximum wall thickness (MWT) vs. LGE-negative patients. Primary outcome: Presence of late gadolinium enhancement (LGE) (AUC 0.80, 95% CI 0.67-0.92).

What question did this study set out to answer?

To assess the relationship between cardiac biomarkers, myocardial strain parameters, left ventricular hypertrophy, and late gadolinium enhancement, evaluating their predictive capacity for myocardial fibrosis in hypertrophic cardiomyopathy patients with preserved ejection fraction.

February 22, 2021Scientific ReportsOpen Access

Predictive values of multiple non-invasive markers for myocardial fibrosis in hypertrophic cardiomyopathy patients with preserved ejection fraction

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Key result

Combining Nt-proBNP and maximum wall thickness detects myocardial fibrosis in HCM with 0.80 AUC.

AUC 0.80
95% CI 0.67-0.92
n=119

Why the study?

Myocardial fibrosis detected by CMR LGE is associated with cardiovascular outcomes in HCM, but little is known about the utility of non-invasive markers for detecting LGE in patients with preserved ejection fraction.

Can non-invasive markers (Nt-proBNP, CMR strain, LV hypertrophy) predict the presence of myocardial fibrosis (LGE) in HCM patients with preserved EF?

Key Points

To assess the relationship between cardiac biomarkers, myocardial strain parameters, left ventricular hypertrophy, and late gadolinium enhancement, evaluating their predictive capacity for myocardial fibrosis in hypertrophic cardiomyopathy patients with preserved ejection fraction.
Recruited 86 patients with hypertrophic cardiomyopathy (HCM) and preserved ejection fraction alongside 33 healthy volunteers.
Conducted contrast-enhanced cardiovascular magnetic resonance (CMR) imaging to evaluate late gadolinium enhancement (LGE), left ventricular wall thickness, and myocardial strain.
Measured serum levels of high-sensitivity cardiac troponin I (hs-cTnI) and N-terminal pro b-type natriuretic peptide (Nt-proBNP), followed by multivariable and ROC curve analyses.
Late gadolinium enhancement was identified in 48 of 86 HCM patients, who demonstrated significantly elevated serum hs-cTnI and Nt-proBNP, alongside decreased global longitudinal and circumferential strains compared to LGE-negative patients.
Percentage of LGE was independently associated with Nt-proBNP levels, global circumferential strain (GCS), left ventricular maximum wall thickness (MWT), and beta-blocker therapy.
A combined threshold of Nt-proBNP ≥ 108.00 pg/mL and MWT ≥ 17.30 mm predicted the presence of LGE with 70.00% sensitivity and 81.25% specificity.

Study Design

Type

Cross-Sectional (n=119)

Multicenter

Structured PICO

Can non-invasive markers (Nt-proBNP, CMR strain, LV hypertrophy) predict the presence of myocardial fibrosis (LGE) in HCM patients with preserved EF?

Population

119 participants, including 86 hypertrophic cardiomyopathy (HCM) patients with preserved ejection fraction and 33 healthy volunteers

Intervention

Assessment of non-invasive markers including serum Nt-proBNP, hs-cTnI, CMR myocardial strain (GLS, GCS), and LV maximum wall thickness (MWT)

Outcome

Presence and extent (LGE%) of myocardial fibrosis assessed by late gadolinium enhancement (LGE) on cardiovascular magnetic resonance (CMR)surrogate

Main Result

Effect estimate: AUC 0.80 (95% CI 0.67-0.92)

Serum Nt-proBNP combined with maximum wall thickness can help identify myocardial fibrosis in HCM patients with preserved EF.

Limitations

The sample size was relatively small
This was a single-centre study, and the HCM subjects were selected with stringent criteria
The laboratory findings of the healthy controls were unavailable
LGE on CMR is limited to identifying diffuse myocardial fibrosis

Discussion

No takes yet. Share an insight, caveat, or question.

Implication

May aid non-invasive fibrosis detection in preserved-EF HCM; hypothesis-generating and requires prospective validation.

Cite This Study

Li et al. (2021) conducted a cross-sectional in Hypertrophic cardiomyopathy with preserved ejection fraction (n=119). Nt-proBNP and maximum wall thickness (MWT) vs. LGE-negative patients was evaluated on Presence of late gadolinium enhancement (LGE) (AUC 0.80, 95% CI 0.67-0.92). The combination of serum Nt-proBNP ≥ 108.00 pg/mL and maximum wall thickness ≥ 17.30 mm demonstrated good diagnostic performance for detecting myocardial fibrosis in HCM patients, with an AUC of 0.80.

synapsesocial.com/papers/6a09080dea37c9c7dbe46b57 https://doi.org/10.1038/s41598-021-83678-z

Topics

Hypertrophic cardiomyopathy

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Predictive values of multiple non-invasive markers for myocardial fibrosis in hypertrophic cardiomyopathy patients with preserved ejection fraction

Key Points

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Topics

Predictive values of multiple non-invasive markers for myocardial fibrosis in hypertrophic cardiomyopathy patients with preserved ejection fraction

Key Points

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Also Consider

Topics

Also Consider