Affiliation:
1. From Johns Hopkins University, Baltimore, MD and Yonsei University College of Medicine, Seoul, South Korea (E.-Y.C.); Yale University, New Haven, CT (H.B.); Office of Biostatistics Research, National Heart, Lung and Blood Institute, Bethesda, MD (C.O.W.); Feinberg School of Medicine at Northwestern University, Chicago, IL (P.G.); Department of Medicine, University of Vermont, Burlington, VT (M.C.); University of California San Diego, La Jolla, CA (L.B.D., M.H.C., A.M.); Johns Hopkins University,...
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.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00005487.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
74 articles.
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