Several biomarkers identified as predictors of outcomes in hypertrophic cardiomyopathy
Blood-based biomarkers for the prediction of hypertrophic cardiomyopathy prognosis: a systematic review and meta-analysisLiterature - Jansen M, Algül S, Bosman LP, et al. - ESC Heart Fail. 2022 Jul 17. doi: 10.1002/ehf2.14073
Introduction and methods
Although the overall mortality of patients with hypertrophic cardiomyopathy (HCM) is low, the clinical severity of this disease is highly variable . Therefore, better risk stratification is desirable, and perhaps biomarkers can meet this need.
Aim of the study
The researchers aimed to review the current knowledge of the prognostic utility of serum and plasma biomarkers in HCM and assess the available evidence, focusing on outcomes involving malignant ventricular arrhythmia (MVA), left ventricular outflow tract (LVOT) obstruction, and HF.
In this systematic review and meta-analysis, 26 unique cohort studies assessing 42 biomarkers in total were included. Risk of bias was assessed with the Quality in Prognostic Studies tool. Two independent authors assessed the study quality.
The primary endpoints were HF, MVA, and LVOT obstruction. Additional composite endpoints were surrogate endpoints for HCM progression (including AF , unexplained syncope, non-sustained ventricular tachycardia, ICD implantation, thromboembolic stroke, and all-cause mortality) and components of the co-primary endpoints.
- In total, 32 biomarkers were significantly associated with an HCM outcome in at least 1 study. Of these, 9 biomarkers showed a significant association in at least 2 studies (BNP, NT-proBNP, eGFR, hs-CRP, hs-cTnT, LDL-c, monocyte count, red blood cell distribution width, and uric acid).
- Pooled analyses could be performed for 5 biomarkers. CV mortality was predicted by NT-proBNP (pooled hazard ratio (HR): 5.38 per log[pg/mL]; 95%CI: 2.07–14.03; P<0.001; heterogeneity index (I2)=0%) and by hs-CRP (pooled HR: 1.30 per μg/mL; 95%CI: 1.00–1.68; P=0.05; I2=78%) but not by glucose (pooled HR: 1.02 per μmol/mL; 95%CI: 0.86–1.21; P=0.82; I2=74%).
- LDL-c predicted all-cause mortality (pooled HR: 0.63 per μmol/mL; 95%CI: 0.49–0.80; P<0.001; I2=0%).
- Hs-cTnT predicted a combined outcome of congestive HF, MVA, and stroke (pooled HR: 4.19 for ≥0.014 ng/mL; 95%CI: 2.22–7.88; P<0.001; I2=0%).
- The overall risk of bias was moderate, and the overall quality of evidence was low–moderate.
In pooled analyses, several biomarkers were identified as predictors of HCM outcomes. The authors stress that further research is required to establish the prognostic utility of these biomarkers for specific outcomes and to evaluate their value when they are incorporated in current risk stratification models.