This study was designed to assess the value of plasma N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) levels in predicting clinical courses in 80 patients with hypertrophic cardiomyopathy. Patients were followed for a mean of 571 +/- 294 days for clinical end points, defined as a composite of cardiovascular death and hospitalization for worsening heart failure symptoms. NT-pro-BNP plasma level (hazard ratio 1.6, 95% confidence interval 1.10 to 2.55, p = 0.015) and New York Heart Association (NYHA) functional class (hazard ratio 3.7, 95% confidence interval 1.17 to 12.09, p = 0.025) were the independent, variables associated with increased risk for experiencing clinical end points. NT-pro-BNP plasma level >= 1,500 pg/ml detected patients with clinical end points with sensitivity, specificity, and accuracy of 83%, 81%, and 81%, respectively. The hypertrophic cardiomyopathy population was stratified into low-, medium-, and high-risk subgroups using 2 simple variables, NYHA functional class and NT-pro-BNP. Patients in lower NYHA classes and with NT-pro-BNP levels < 1,500 pg/ml were significantly free of clinical end points. In conclusion, for patients with hypertrophic cardiomyopathy, plasma levels of NT-pro-BNP seem a reliable parameter to identify those at risk for clinical deterioration at long-term follow-up in conjunction with symptomatic status. (c) 2006 Elsevier Inc. All rights reserved.