Author + information
- Manan Pareeka,b,
- Deepak L. Bhatta,b,
- Muthiah Vaduganathana,b,
- Tor Biering-Sørensena,b,
- Jacob E. Møllera,b,
- Margrét Leósdóttira,b,
- Martin Magnussona,b,
- Peter M. Nilssona,b and
- Michael Olsena,b
Background: N-terminal prohormone of brain natriuretic peptide (NT-proBNP) is a valuable marker of cardiac wall stress. Limited data are available exploring the relative prognostic value of this biomarker in the context of key echocardiographic measures of cardiac structure and function, especially in subjects without cardiovascular disease.
Methods: We conducted a prospective population-based cohort study of 691 healthy subjects and 922 patients who had established cardiovascular disease or were treated with cardiovascular agents. All subjects underwent baseline transthoracic echocardiography and NT-proBNP measurement. The primary endpoint was the composite of coronary events, heart failure, stroke, and all-cause mortality. Prognostic properties were evaluated using Kaplan-Meier analysis, Cox regression models, Harrell's C-index, and net reclassification improvement (NRI).
Results: Median baseline NT-proBNP levels in healthy subjects and patients were 8 (interquartile range (IQR): 5-15) and 15 (IQR: 7-30) (pmol/L), respectively. During a median follow-up of 9.0 (IQR: 8.3-9.7) years, 513 composite events occurred (31.8%). In the healthy cohort, NT-proBNP was a significant predictor of the primary endpoint after accounting for age, sex, smoking status, systolic blood pressure, total cholesterol, body mass index, and cystatin C levels (HR Q4 vs. Q1 1.83 (95% CI: 1.00-3.36), p=0.049) or left ventricular hypertrophy and/or grade 2 or 3 diastolic dysfunction (LVH/DD; HR Q4 vs. Q1 2.42 (95% CI: 1.39-4.20), p=0.002). NT-proBNP Q4 added to the discrimination ability of LVH/DD alone (C-index NT-proBNP+LVH/DD 0.600 (95% CI: 0.552-0.648) vs. C-index LVH/DD alone 0.551 (95% CI: 0.509-0.593), p=0.01) with significant NRI (0.31 (95% CI: 0.13-0.49), p=0.0008). Similar, but more robust, results were seen in the patient group, in which the combined model also performed better than NT-proBNP alone.
Conclusions: Elevated NT-proBNP levels are independently predictive of long-term cardiovascular risk and improve risk classification beyond that of LVH and echocardiographic markers of diastolic function, in both healthy subjects and patients with known cardiovascular disease.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Making Progress in Understanding Heart Failure
Abstract Category: 13. Heart Failure and Cardiomyopathies: Clinical
Presentation Number: 1123-296
- 2017 American College of Cardiology Foundation