N-terminal pro-b-type natriuretic peptide, left ventricular mass, and incident heart failure

Eui Young Choi, Hossein Bahrami, Colin O. Wu, Philip Greenland, Mary Cushman, Lori B. Daniels, Andre L C Almeida, Kihei Yoneyama, Anders Opdahl, Aditya Jain, Michael H. Criqui, David Siscovick, Christine Darwin, Alan Maisel, David A. Bluemke, Joao A C Lima

Research output: Contribution to journalArticlepeer-review

49 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)727-734
Number of pages8
JournalCirculation: Heart Failure
Volume5
Issue number6
DOIs
StatePublished - Nov 2012
Externally publishedYes

Keywords

  • Heart failure
  • Left ventricular mass
  • N-terminal pro-B-type natriuretic peptide

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