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N-terminal pro-B-type natriuretic peptide, left ventricular mass, and incident heart failure: Multi-Ethnic Study of
Eui-Young Choi1, Hossein Bahrami, Colin O Wu
1Johns Hopkins University, Baltimore, MD, USA.
Insights
Elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) predicts heart failure (HF) in asymptomatic individuals. NT-proBNP offers crucial prognostic information beyond traditional risk factors and LV mass index.
Area of Science:
- Cardiology
- Biomarkers
- Preventive Medicine
Background:
- Elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) is linked to overt heart failure (HF).
- Prognostic value of NT-proBNP for incident HF in asymptomatic, multi-ethnic populations remains unclear.
- The role of NT-proBNP alongside traditional risk factors and left ventricular (LV) mass index needs investigation.
Purpose of the Study:
- To assess the association of plasma NT-proBNP and LV mass index with incident HF.
- To determine if NT-proBNP provides additive prognostic value in asymptomatic individuals.
- To evaluate these associations across diverse ethnic groups.
Main Methods:
- Studied 5597 multi-ethnic asymptomatic participants without cardiovascular disease.
- Measured baseline NT-proBNP and LV mass index (via cardiac MRI in 4163).
- Followed participants for incident HF over 5.5 years.
Main Results:
- Higher NT-proBNP levels significantly predicted incident HF, independent of numerous risk factors and LV mass index.
- This association was consistent across non-Hispanic whites, African-Americans, and Hispanics.
- NT-proBNP demonstrated significant additive prognostic value for incident HF prediction.
Conclusions:
- Plasma NT-proBNP offers incremental prognostic information for incident symptomatic HF.
- This value is significant beyond traditional risk factors and MRI-defined LV mass index.
- NT-proBNP is a valuable biomarker for risk stratification in asymptomatic, multi-ethnic populations.
Background:
Elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) is associated with clinically overt heart failure (HF). However, whether it provides additive prognostic information for incident HF beyond traditional risk factors and left ventricular (LV) mass index among multi-ethnic asymptomatic individuals has not yet been determined. We studied the associations of plasma NT-proBNP and magnetic resonance imaging defined LV mass index with incident HF in an asymptomatic multi-ethnic population.
Methods And Results:
A total of 5597 multi-ethnic participants without clinically apparent cardiovascular disease underwent baseline measurement of NT-proBNP and were followed for 5.5±1.1 years. Among them, 4163 also underwent baseline cardiac magnetic resonance imaging. During follow-up, 111 participants experienced incident HF. Higher NT-proBNP was significantly associated with incident HF, independent of baseline age, sex, ethnicity, systolic blood pressure, diabetes mellitus, smoking, estimated glomerular filtration rate, medications (anti-hypertensive and statin), LV mass index, and interim myocardial infarction (hazard ratio: 1.95 per 1U log NT-proBNP increment, 95% CI 1.54-2.46, P<0.001). This relationship held among different ethnic groups, non-Hispanic whites, African-Americans, and Hispanics. Most importantly, NT-proBNP provided additive prognostic value beyond both traditional risk factors and LV mass index for predicting incident HF (integrated discrimination index=0.046, P<0.001; net reclassification index; 6-year risk probability categorized by <3%, 3-10%, >10% =0.175, P=0.019; category-less net reclassification index=0.561, P<0.001).
Conclusions:
Plasma NT-proBNP provides incremental prognostic information beyond traditional risk factors and the magnetic resonance imaging-determined LV mass index for incident symptomatic HF in an asymptomatic multi-ethnic population.
Clinical Trial Registration:
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00005487.
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