Circulation, Vol 88, 372-380, Copyright © 1993 by American Heart Association
K Hasegawa, H Fujiwara, K Doyama, M Miyamae, T Fujiwara, S Suga, M Mukoyama, K Nakao, H Imura and S Sasayama
BACKGROUND. Brain natriuretic peptide (BNP), as a cardiac hormone, is
expressed together with atrial natriuretic peptide (ANP) in the ventricles
in congestive heart failure. However, the ventricular expression of BNP in
hypertrophic cardiomyopathy (HCM) with normal systolic function is still
unclear. METHODS AND RESULTS. The study population consisted of 39 HCM
patients with asymmetric septal hypertrophy and 10 control subjects without
any specific cardiac disease. Eleven cases of HCM were obstructive (HOCM),
and the other 28 cases were nonobstructive (HNCM). All of these patients
had a normal ejection fraction. Immunohistochemical analysis of
endomyocardial biopsy specimens with specific monoclonal antibodies showed
BNP immunoreactivity in the HOCM group (5/10, 50%) but not in the HNCM
group (0/22) or in control subjects (0/5). In HOCM, left ventricular
end-diastolic pressure was significantly higher in the BNP-positive
patients than the BNP-negative patients. Histological changes such as
myocardial fiber disarray, hypertrophy of myocytes, and fibrosis were
greater in BNP-positive patients than BNP-negative patients in HCM.
However, the expression had no significant relation with other clinical
parameters. The elevation of the BNP plasma level versus control subjects
was marked in both HOCM (85-fold) and HNCM (23-fold). By contrast, the
elevation of the ANP plasma level versus control subjects was mild in HOCM
(5.7-fold) and HNCM (4.2-fold). The ratio of BNP level to ANP level was
higher in HOCM (4.16) than in HNCM (1.46) and control subjects (0.28), and
it was higher than the ratio previously reported for severe congestive
heart failure (1.72). CONCLUSIONS. These findings suggest that BNP is
expressed in the ventricular myocytes of HCM with normal systolic function.
In HOCM, ventricular expression of BNP may be augmented in response to both
obstruction and diastolic dysfunction.
ARTICLES
Ventricular expression of brain natriuretic peptide in hypertrophic cardiomyopathy
Department of Internal Medicine, Faculty of Medicine, Kyoto University, Japan.
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