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A comparison of echocardiographic and circulating cardiac biomarkers for predicting incident cardiovascular disease
Lars Lind1, Jordan Loader1,2, Bertil Lindahl1
1Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
Insights
Echocardiographic measures like enlarged left atrial diameter and low ejection fraction predict cardiovascular disease (CVD) in older adults. However, blood tests (troponin I and NT-proBNP) showed similar predictive value for CVD events.
Area of Science:
- Cardiology
- Gerontology
- Biomarkers
Background:
- Echocardiographic measures are established cardiovascular disease (CVD) predictors in the general population.
- This study investigated the predictive capabilities of echocardiography versus cardiac biomarkers for CVD outcomes in an aging cohort.
Purpose of the Study:
- To compare the predictive value of echocardiographic measures and cardiac biomarkers for incident CVD in older adults.
- To assess the incremental predictive value of these measures when added to traditional CVD risk factors.
Main Methods:
- A prospective, population-based cohort study of 1016 individuals aged 70 years.
- Echocardiography, traditional CVD risk factors, and cardiac biomarkers (NT-proBNP, troponin I) were assessed at baseline and repeated.
- A composite CVD outcome was tracked over 15 years using Cox proportional hazard analyses.
Main Results:
- Enlarged left atrial diameter and low left ventricular ejection fraction (LVEF) were independently associated with incident CVD.
- Adding LA diameter and LVEF to traditional risk factors improved CVD prediction (C-statistic increase of 1.5%).
- Circulating cardiac biomarkers (troponin I, NT-proBNP) improved CVD prediction more significantly (C-statistic increase of 3.0%).
Conclusions:
- Echocardiographic measures, specifically enlarged left atrial diameter and low LVEF, enhance CVD risk prediction in older adults.
- Circulating cardiac biomarkers (troponin I, NT-proBNP) offer comparable or superior predictive improvement over echocardiography.
- The findings support the utility of simple blood tests for improving clinical CVD risk prediction in aging populations.
Background:
Echocardiographic measures are known predictors of cardiovascular disease (CVD) in the general population. This study compared the predictive value of such measures to that of circulating cardiac biomarkers for a composite cardiovascular disease outcome in an aging population.
Methods:
In this prospective population-based cohort study, echocardiography was performed at baseline together with assessments of traditional CVD risk factors and circulating cardiac biomarkers, NT-proBNP and troponin I, in 1016 individuals all aged 70 years. Assessments were repeated at ages 75 and 80. A composite CVD outcome (myocardial infarction, heart failure or ischemic stroke) was charted over 15 years. All echocardiography variables, except for the E/A ratio, were analyzed on a continuous scale.
Results:
Over 10 years, left atrial (LA) diameter, left ventricular mass index (LVMI) and high E/A ratio (>1.5) increased, while left ventricular ejection fraction (LVEF) remained unchanged. Using Cox proportional hazard analyses with time-updated variables for echocardiographic measures and traditional risk factors, an enlarged LA diameter and a low LVEF were independently related to incident CVD in 222 participants. The addition of LA diameter and LVEF to traditional risk factors increased the C-statistic by 1.5% (p = 0.008). However, the addition of troponin I and NT-proBNP to traditional risk factors increased the C-statistic by 3.0% (p<0.001).
Conclusion:
An enlarged LA diameter and a low LVEF improved the prediction of incident CVD compared to traditional risk factors. However, given that troponin I and NT-proBNP improved prediction to a similar extent, the use of simple blood tests to improve clinical cardiovascular disease risk prediction is only further supported by this study.
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