N-terminal pro-B-type natriuretic peptide, left ventricular mass, and incident heart failure: Multi-Ethnic Study of Atherosclerosis

EY Choi, H Bahrami, CO Wu, P Greenland… - Circulation: heart …, 2012 - Am Heart Assoc
EY Choi, H Bahrami, CO Wu, P Greenland, M Cushman, LB Daniels, ALC Almeida…
Circulation: heart failure, 2012Am Heart Assoc
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 …
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.
Am Heart Assoc