ypertrophic cardiomyopathy (HCM) characteristically has severe myocardial hypertrophy, predominantly involving the interventricular septum of the nondilated left ventricle. Echocardiography is useful for the differential diagnosis of HCM, but it can be difficult to distinguish HCM from hypertensive heart disease (HHD) with left ventricular (LV) hypertrophy. Although concentric LV hypertrophy is observed in patients with HCM 1 and sometimes HCM patients present with hypertension as a complication, asymmetrical interventricular hypertrophy (ASH) is also observed in HHD. 2,3 Recently, ultrasonic myocardial tissue characterization by integrated backscatter has provided additional information about the pathological changes; however, it is still unable to completely differentiate HCM from HHD. 4 It has been reported that various neurohumoral systems are accelerated in patients with HHD or HCM. In HHD, the plasma concentrations of epinephrine and norepinephrine are increased, 5,6 and other trophic neurohumoral factors, such as angiotensin II 7 and endothelin-1, 8 are also increased. Moreover, it has been reported that atrial natriuretic peptide (ANP) is increased in patients with hypertension. 9 With regard to HCM patients, it has been reported that plasma concentrations of catecholamines 10 and endothelin-1 11 are increased, as well as those of ANP and brain natriuretic peptide (BNP). [12][13][14][15][16] However, there are no data on the differences in the neurohumoral profiles of HCM and HHD patients.Thus, in the present study we measured the plasma concentrations of catecholamines (epinephrine and norepinephrine), angiotensin II, endothelin-1 and natriuretic peptides (ANP and BNP) in patients with HCM and HHD without LV dysfunction to clarify the neurohumoral profile of HCM and its clinical implications.
Methods
SubjectsWe studied 40 patients with HCM, 35 with HHD and 15 healthy normal controls (Protocol 1). All patients were clinically evaluated and carefully diagnosed based on their family history, history of hypertension, echocardiography (UCG) and cardiac catheterization. 17,18 Patients with angina pectoris, low LV ejection fraction (LVEF: <50%), valvular heart disease, liver injury or renal dysfunction were excluded because all of these factors have effects on the Circ J 2004; 68: 444 -450 (Received November 28, 2003; revised manuscript received February 6, 2004; accepted February 13, 2004 Background Patients with hypertrophic cardiomyopathy (HCM) or hypertensive heart disease (HHD) have increased concentrations of various neurohumoral factors. Thus, the aim of the present study was to evaluate the differences in the neurohumoral profiles of HCM and HHD. Methods and Results Plasma concentrations of epinephrine, norepinephrine, atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), angiotensin II and endothelin-1 were measured in 40 patients with HCM, 35 with HHD, and 15 controls. Additionally, the concentrations of these neurohumoral factors in the coronary sinus and aortic root were measured in...