Reclassification of Pre-Heart Failure Stages Using Cardiac Biomarkers: The ARIC Study

Area of Science:

• Cardiology
• Biomarkers
• Heart Failure Staging

Background:

• Recent heart failure (HF) guidelines advocate for integrating cardiac biomarkers in the definition of Stage B HF.
• This approach aims to enhance the identification and risk stratification of individuals with preclinical cardiac dysfunction.

Purpose of the Study:

• To evaluate the impact of incorporating cardiac biomarkers (N-terminal pro-B-type natriuretic peptide and high-sensitivity troponin T) and echocardiography in reclassifying Stage B HF.
• To assess the prognostic value of Stage B HF defined by biomarkers and/or echocardiographic abnormalities for incident HF and all-cause mortality.

Main Methods:

• The Atherosclerosis Risk In Communities (ARIC) study cohort, comprising 5,324 participants without prevalent HF, was analyzed.
• Participants were classified into Stage A_new and Stage B_new HF based on biomarker levels and cardiac structure/function determined by echocardiography.
• Cox regression models were used to assess the risk of incident HF and all-cause death.

Main Results:

• Approximately 81.3% of participants were reclassified to Stage B_new HF, with 21.1% having elevated biomarkers only.
• Stage B_new HF was significantly associated with increased risks of incident HF (HR: 3.70) and all-cause death (HR: 1.94) compared to Stage A_new HF.
• Individuals with both biomarker and echocardiographic abnormalities (Stage B_echo+biomarker) exhibited the highest risks for HF (HR: 6.34) and death (HR: 2.53).

Conclusions:

• The integration of cardiac biomarkers into HF staging reclassifies a substantial proportion of older adults without diagnosed HF to Stage B.
• Routine biomarker measurement aids in identifying high-risk individuals who could benefit from targeted HF prevention strategies.
• Biomarker-based HF staging provides valuable prognostic information for both incident HF and mortality risk.