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Risk scores versus natriuretic peptides for identifying prevalent stage B heart failure
Sachin Gupta1, Anand Rohatgi, Colby R Ayers
1Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, USA.
Insights
Screening for stage B heart failure (HF) is improved by combining traditional risk scores with natriuretic peptide biomarkers. This approach enhances the identification of asymptomatic individuals at risk for developing symptomatic HF.
Area of Science:
- Cardiology
- Preventive Medicine
- Biomarker Research
Background:
- Identifying asymptomatic stage B heart failure (HF) is crucial for preventing symptomatic progression.
- The comparative effectiveness of risk scores versus biomarkers for screening stage B HF is not well-established.
Purpose of the Study:
- To compare the utility of traditional risk scores against natriuretic peptide biomarkers in identifying prevalent stage B HF.
- To evaluate the added value of combining risk scores with natriuretic peptides for stage B HF screening.
Main Methods:
- Analysis of 2,277 participants (30-65 years) from the Dallas Heart Study without symptomatic HF.
- Stage B HF defined by left ventricular hypertrophy, reduced ejection fraction, or prior myocardial infarction.
- Comparison of Health Aging and Body Composition and Framingham Heart Failure risk scores against B-type natriuretic peptide (BNP) and N-terminal pro-BNP using logistic regression.
Main Results:
- Health Aging and Body Composition HF risk score demonstrated superior discrimination for stage B HF compared to BNP and N-terminal pro-BNP.
- Framingham Heart Failure risk score also showed comparable or superior performance to natriuretic peptides.
- Adding natriuretic peptides to risk scores provided a modest but significant improvement in identifying stage B HF.
Conclusions:
- Screening for stage B HF is more effective when natriuretic peptides are used alongside traditional risk scores.
- Measuring natriuretic peptides in addition to risk scores enhances the detection of early-stage heart failure.
- This combined approach offers a more robust strategy for population-based HF screening.
Background:
Identifying asymptomatic individuals with American Heart Association/American College of Cardiology stage B heart failure (HF) in the population is an important step to prevent the development of symptomatic HF. The comparative utility of 2 screening strategies (biomarkers vs risk scores) in identifying prevalent stage B HF is unknown.
Methods:
Participants 30 to 65 years old without symptomatic HF in the Dallas Heart Study who had a cardiac magnetic resonance imaging were included (n = 2,277). Stage B HF (n = 284) was defined by left ventricular (LV) hypertrophy, reduced LV ejection fraction, or prior myocardial infarction. We compared the utility of 2 risk scores (Health Aging and Body Composition HF risk score and the Framingham Heart Failure risk score) with B-type natriuretic peptide (BNP) and N-terminal pro-BNP in identifying stage B HF using logistic regression.
Results:
Depending upon the method of indexing LV mass (body surface area, fat-free mass, or height(2.7)), the c-statistic for the Health Aging and Body Composition HF risk score (0.73, 0.75, and 0.64, respectively) was greater than that for BNP (0.62, 0.70, and 0.57, respectively) and N-terminal pro-BNP (0.62, 0.69, and 0.56, respectively) (P < .01 for all). These findings were similar for the Framingham Heart Failure risk score except when LV mass was indexed to fat-free mass. Addition of natriuretic peptide levels to the risk scores resulted in a modest but significant improvement in discrimination of stage B HF (Δ c-statistic, 0.01-0.03, P < .05 for all).
Conclusions:
Screening for stage B HF in the population is enhanced when natriuretic peptides are measured in addition to, rather than in place of, traditional risk scores.
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