Related Experiment Video
Updated: Apr 5, 2026
Coronary Progenitor Cells and Soluble Biomarkers in Cardiovascular Prognosis after Coronary Angioplasty
Published on: January 28, 2020
Plasma pro-brain natriuretic peptide and electrocardiographic changes in combination improve risk prediction in
Peter G Jørgensen1, Jan S Jensen1, Merete Appleyard2
1The Copenhagen City Heart Study, Frederiksberg Hospital, Nordre Fasanvej 57, DK-2000 Frederiksberg, Denmark; Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, DK-2900 Hellerup, Denmark; Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3B, DK-2200 Copenhagen N., Denmark.
Insights
Combining electrocardiogram (ECG) changes and plasma pro-brain-natriuretic-peptide (pro-BNP) significantly improves cardiovascular disease risk prediction. This combined approach offers better identification of individuals at risk for mortality and cardiovascular events.
Area of Science:
- Cardiology
- Preventive Medicine
- Biomarker Research
Background:
- Electrocardiogram (ECG) and pro-brain-natriuretic-peptide (pro-BNP) are established markers for subclinical cardiac injury and cardiovascular disease (CVD) risk.
- The independent predictive value of ECG changes and pro-BNP, and their combined utility, requires further investigation in asymptomatic populations.
Purpose of the Study:
- To assess whether ECG changes and pro-BNP are independent predictors of future CVD events.
- To determine if the combination of ECG changes and pro-BNP enhances CVD risk prediction in individuals without pre-existing heart disease.
Main Methods:
- Prospective cohort study involving 5454 participants without known heart disease.
- Measurement of plasma pro-BNP and ECGs, with a median follow-up of 10.4 years.
- Analysis of all-cause mortality and a composite endpoint of ischemic heart disease, heart failure, or CVD death.
Main Results:
- Both high pro-BNP levels and ECG changes were independently associated with increased risk of all-cause mortality and CVD events.
- The combination of high pro-BNP and ECG changes demonstrated a significantly higher hazard ratio for both outcomes compared to individual markers.
- The combined assessment led to substantial improvements in risk reclassification for both all-cause mortality (33.9%) and CVD events (49.7%).
Conclusions:
- ECG changes and pro-BNP are significant independent predictors of cardiovascular outcomes.
- The combined use of ECG and pro-BNP provides additive value in predicting cardiovascular risk in the general population.
- Integrating these markers into risk assessment models can improve the identification of individuals requiring closer monitoring or intervention.
Background:
Though the electrocardiogram(ECG) and plasma pro-brain-natriuretic-peptide (pro-BNP) are widely used markers of subclinical cardiac injury and can be used to predict future cardiovascular disease(CVD), they could merely be markers of the same underlying pathology. We aimed to determine if ECG changes and pro-BNP are independent predictors of CVD and if the combination improves risk prediction in persons without known heart disease.
Methods:
Pro-BNP and ECG were obtained on 5454 persons without known heart disease from the 4th round of the Copenhagen City Heart Study, a prospective cohort study. Median follow-up was 10.4 years. High pro-BNP was defined as above 90th percentile of age and sex adjusted levels. The end-points were all-cause mortality and the combination of admission with ischemic heart disease, heart failure or CVD death.
Results:
ECG changes were present in 907 persons and were associated with high levels of pro-BNP. In a fully adjusted model both high pro-BNP and ECG changes remained significant predictors: all-cause mortality(high pro-BNP, no ECG changes: HR: 1.43(1.12-1.82);P=0.005, low pro-BNP, ECG changes: HR: 1.22(1.05-1.42);P=0.009, and both high pro-BNP and ECG changes: HR: 1.99(1.54-2.59);P<0.001), CVD event(high pro-BNP, no ECG changes: HR: 1.94(1.45-2.58);P<0.001, low pro-BNP, ECG changes: HR: 1.55(1.29-1.87);P<0.001, and both high pro-BNP and ECG changes: HR: 3.86(2.94-5.08);P<0.001). Adding the combination of pro-BNP and ECG changes to a fully adjusted model correctly reclassified 33.9%(26.5-41.3);P<0.001 on the continuous net reclassification scale for all-cause mortality and 49.7%(41.1-58.4);P<0.001 for CVD event.
Conclusion:
Combining ECG changes and pro-BNP improves risk prediction in persons without known heart disease.
More Related Videos
04:20Integration of Brain Tissue Saturation Monitoring in Cardiopulmonary Exercise Testing in Patients with Heart Failure
Published on: October 1, 2019
08:49Author Spotlight: Enhancing Graft Viability Assessment Through Quantitative Metrics and Innovative Reservoir Systems
Published on: August 2, 2024
Related Concept Videos
01:19Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
01:29Heart Failure II: Pathophysiology
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
01:29Cardiomyopathy III: Hypertrophic Cardiomyopathy
01:17Hormonal Regulation of Blood Pressure
Epinephrine and Norepinephrine
The adrenal medulla releases epinephrine and norepinephrine, catecholamines that enhance and extend the sympathetic or "fight or flight" physiological response. These hormones escalate heart rate and the force of contraction...