Inflammatory and Cardiac Biomarkers in Obstructive and Non-Obstructive Hypertrophic Cardiomyopathy: A Review

Abstract

Background: Hypertrophic cardiomyopathy (HCM) is a genetically determined cardiac disorder characterized by asymmetric left ventricular hypertrophy, with or without left ventricular outflow tract obstruction. Inflammatory cytokines and cardiac biomarkers have been increasingly implicated in its pathogenesis, disease progression, and clinical outcomes. Interleukins (IL-1, IL-6), tumor necrosis factor-alpha (TNF-α), C-reactive protein (CRP), and natriuretic peptides such as B-type natriuretic peptide (BNP) and its precursor fragment NT-proBNP provide valuable insights into myocardial stress and systemic inflammation.

Material and Methods: This review compiles evidence from studies assessing serum concentrations of IL-1, IL-6, TNF-α, CRP, BNP, and NT-proBNP in obstructive hypertrophic cardiomyopathy (OHCM), non-obstructive HCM (NOHCM), and healthy controls. PubMed, Scopus, and Embase were searched for articles published up to 2022 using keywords “Hypertrophic Cardiomyopathy,” “Obstructive,” “Cytokines,” “BNP,” and “Inflammation.” Comparative analyses from observational studies, case–control cohorts, and experimental models were reviewed.

Conclusion: Evidence suggests that patients with OHCM and NOHCM exhibit significantly higher circulating levels of pro-inflammatory cytokines and natriuretic peptides compared to healthy controls. OHCM patients generally display greater biomarker elevation, reflecting higher hemodynamic stress and inflammatory activation. Elevated IL-6 and TNF-α correlate with myocardial fibrosis, while BNP and NT-proBNP are strongly associated with symptom severity, arrhythmic risk, and progression to heart failure. Understanding these biomarker profiles may aid in risk stratification, therapeutic monitoring, and potential incorporation of anti-inflammatory strategies in HCM management.