| Objective:Hypertrophic cardiomyopathy(HCM)is a kind of primary cardiomyopathy with unknown etiology,which is considered to be hereditary cardiomyopathy by some experts and has a multi-family history.The prevalence of HCM is estimated to be at least 800,000 in the United States,more than 1 million in Europe,and the prevalence of HCM is 0.20%in several heart centers in China,the age-and sex-adjusted prevalence rate was 0.10%,which estimated that there were more than 1 million HCM patients in China.HCM is one of the causes of sudden death,and is more common in adults and adolescents.Sudden Cardiac Death(SCD)is one of the main causes of death.The annual cardiac mortality rate in adults with hypertrophic cardiomyopathy is 1-2%.Some clinical indicators(non-persistent ventricular Tachycardia,maximal left ventricular wall thickness≥30 mm,SCD family history,unexplained syncope and abnormal postexercise blood pressure)are used to assess risk and guide ICD(implantable artificial pacemaker)therapy.These methods have limitations,in particular that they assess relative risk rather than absolute risk;they do not explain differences in the number of individual risk factors,some of which,for example,left ventricular wall thickness was used as a binary variable when the risk of death continued to increase.As a result,current risk assessments do not effectively distinguish between high-risk and low-risk patients.Other clinical indicators,such as myocardial fibrosis,left ventricular apical aneurysm and multiple sarcomere gene variants,were used to guide ICD implantation in patients at risk.However,there is little evidence to support this.The aim of this study was to analyze the relationship between b-type natriuretic Peptide(BNP)and high-sensitivity Cardiac Troponin I(hs-cTnI)with prognosis and clinical manifestations in patients with hypertrophic cardiomyopathy(HCM).To provide more controllable factors for the treatment and prognosis of HCM patients.Methods:A total of 51 patients with HCM who were treated in hospital from June 2018 to June 2019 were observed.All patients were aged between 49 and 71 years.The clinical data and prognosis data were analyzed by regression analysis.Cardiovascular adverse events include sudden death,heart failure-related death,stroke-related death,embolism events and so on.BNP>100 PG/M1 was defined as BNP elevation,hs-cTnI>0.1 Ug/L was defined as hs-tni elevation.Group A and Group B were divided according to whether cardiovascular adverse events occurred.17 patients with cardiovascular adverse events were included in Group A,and 34 patients without cardiovascular adverse events were included in group B.Combined with BNP and hs-cTnI levels,29 patients with elevated BNP and hs-cTnI were included in the elevated group,and 22 patients without elevated BNP and hs-cTnI were included in the normal group.The correlation between BNP,hs-tni and prognosis and clinical manifestation in patients with hypertrophic cardiomyopathy were studied by statistical analysis.Results:(1)there were significant differences in cardiac function(grade ⅲ-ⅳ),BNP and hs-cTnI between the groups with and without cardiovascular events(p<0.05).There were no significant differences in age and sex between the patients with history of diseases such as atrial fibrillation,Bradyarrhythmia,myocardial bridge and Apical hypertrophic cardiomyopathy(p>0.05).There was significant difference in syncope time(p<0.05).There were statistical significance in complications,family history and treatment plan(p<0.05).Logistic Regression analysis showed that there was a statistical significance between the increase of BNP and hs-cTnI(p<0.05).(2)there was no significant difference in age,sex and family history between the groups with elevated BNP and hs-cTnI compared with the normal group(p>0.05).There were significant differences in the history of syncope,atrial fibrillation,Bradyarrhythmia,myocardial bridge and the history of Apical hypertrophic cardiomyopathy(p<0.05),there was no significant difference among other medical history(p>0.05).There was significant difference in heart function(iii-iv)between the two groups(p<0.05).There was no significant difference between the two groups except amiodarone and propafenone(p<0.05)in the application of other treatment regimens(p>0.05).There was significant difference in the maximal wall thickness between the two groups(p<0.05).The factors influencing the increase of BNP and hs-cTnI were analyzed by binary Logistic regression,and there was statistical significance between the increase of BNP and hs-cTnI(p<0.05).(3)In terms of patient prognosis:51 patients in this group obtained complete follow-up data.The results of 3 follow-ups were:17 patients had adverse cardiovascular events,and 17 patients had a poor prognosis.BNP and hs-cTnI increased simultaneously in 17 patients with poor prognosis.Five patients died,with a mortality rate of 9.80%.The specific causes were:sudden death in one patient,progressive death in one patient with heart failure,one death in patients with ventricular fibrillation,one death in sepsis,Patients died based on hypoglycemic encephalopathy.Two patients had sustained ventricular tachycardia,three had recurrent atrial fibrillation,four had paroxysmal chest tightness,and three had had ischemic stroke.Conclusion:based on the above findings,the conclusions are summarized as follows:(1)the age of diagnosis and the increase of BNP and hs-cTnI have certain reference value for predicting the occurrence of cardiovascular adverse events in HCM,the elevated levels of BNP AND hs-cTnI were independent risk factors for cardiovascular adverse events in HCM patients.(2)atrial fibrillation(AF)and maximal ventricular wall thickness(mwt)can significantly affect BNP andhs-cTnI levels in patients and should be monitored.(3)patients with elevated BNP and hs-cTnI were more likely to receive amiodarone or propafenone antiarrhythmic agent. |
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