Heart Care Info - Heart Disease Prevention & Treatment

Echocardiography, Natriuretic Peptides, and Risk for Incident Heart Failure in Older Adults: The Cardiovascular Health Study

AP Kalogeropoulos... - JACC ..., 2012 - ... Screening the population for left ventricular hypertrophy and left ventricular systolic dysfunction using natriuretic peptides: results from the Dallas Heart Study Am Heart J 2009;157:74653.e2. Atherton J. Screening for left ventricular systolic dysfunction: is imaging a solution? ...

Andreas P. Kalogeropoulos, MD*, Vasiliki V. Georgiopoulou, MD*, Christopher R. de Filippi, MD, John S. Gottdiener, MD, Javed Butler, MD, MPH*,* Cardiovascular Health Study

* Reprint requests and correspondence: Dr. Javed Butler, Emory Clinical Cardiovascular Research Institute, 1462 Clifton Road NE, Suite 504, Atlanta, Georgia 30322 (Email: javed.butler{at}emory.edu).

Background: Without clinical guidance, echocardiography and natriuretic peptides have suboptimal test characteristics for population-wide HF risk stratification. However, the value of these tests has not been examined in concert with a clinical HF risk score.

Methods: We evaluated the improvement in 5-year HF risk prediction offered by adding an echocardiographic score and/or NT-pro BNP levels to the clinical Health Aging and Body Composition (ABC) HF risk score (base model) in 3,752 participants of the CHS (Cardiovascular Health Study) (age 72.6 5.4 years; 40.8% men; 86.5% white). The echocardiographic score was derived as the weighted sum of independent echocardiographic predictors of HF. We assessed changes in Bayesian information criterion (BIC), C index, integrated discrimination improvement (IDI), and net reclassification improvement (NRI). We examined also the weighted NRI across baseline HF risk categories under multiple scenarios of event versus nonevent weighting.

Results: Reduced left ventricular ejection fraction, abnormal E/A ratio, enlarged left atrium, and increased left ventricular mass were independent echocardiographic predictors of HF. Adding the echocardiographic score and NT-pro BNP levels to the clinical model improved BIC (echocardiography: 43, NT-pro BNP: 64.1, combined: 68.9; all p < 0.001) and C index (baseline: 0.746; echocardiography: +0.031, NT-pro BNP: +0.027, combined: +0.043; all p < 0.01), and yielded robust IDI (echocardiography: 43.3%, NT-pro BNP: 42.2%, combined: 61.7%; all p < 0.001), and NRI (based on Health ABC HF risk groups; echocardiography: 11.3%; NT-pro BNP: 10.6%, combined: 16.3%; all p < 0.01). Participants at intermediate risk by the clinical model (5% to 20% 5-yr HF risk; 35.7% of the cohort) derived the most reclassification benefit. Echocardiography yielded modest reclassification when used sequentially after NT-pro BNP.

Key Words: epidemiology heart failure risk prediction risk score risk stratification