@article {1365, title = {Echocardiography, natriuretic peptides, and risk for incident heart failure in older adults: the Cardiovascular Health Study.}, journal = {JACC Cardiovasc Imaging}, volume = {5}, year = {2012}, month = {2012 Feb}, pages = {131-40}, abstract = {

OBJECTIVES: This study sought to examine the potential utility of echocardiography and N-terminal pro-B-type natriuretic peptide (NT-proBNP) for heart failure (HF) risk stratification in concert with a validated clinical HF risk score in older adults.

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-proBNP 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 {\textpm} 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-proBNP levels to the clinical model improved BIC (echocardiography: -43, NT-proBNP: -64.1, combined: -68.9; all p < 0.001) and C index (baseline: 0.746; echocardiography: +0.031, NT-proBNP: +0.027, combined: +0.043; all p < 0.01), and yielded robust IDI (echocardiography: 43.3\%, NT-proBNP: 42.2\%, combined: 61.7\%; all p < 0.001), and NRI (based on Health ABC HF risk groups; echocardiography: 11.3\%; NT-proBNP: 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-proBNP.

CONCLUSIONS: In older adults, echocardiography and NT-proBNP offer significant HF risk reclassification over a clinical prediction model, especially for intermediate-risk individuals.

}, keywords = {Aged, Biomarkers, Cardiomegaly, Echocardiography, Female, Heart Failure, Humans, Male, Natriuretic Peptide, Brain, Peptide Fragments, Risk, Risk Assessment, Ventricular Function, Left}, issn = {1876-7591}, doi = {10.1016/j.jcmg.2011.11.011}, author = {Kalogeropoulos, Andreas P and Georgiopoulou, Vasiliki V and deFilippi, Christopher R and Gottdiener, John S and Butler, Javed} }