03385nas a2200421 4500008004100000022001400041245017900055210006900234260001600303300001300319490000700332520212700339653001602466653000902482653002202491653001502513653001902528653001002547653001102557653002202568653001802590653001102608653000902619653003102628653002202659653002402681653001702705653001802722653001802740653003102758100003002789700002702819700001902846700002402865700001402889700002402903856003602927 2011 eng d a1558-359700aLeft ventricular ejection fraction assessment in older adults: an adjunct to natriuretic peptide testing to identify risk of new-onset heart failure and cardiovascular death?0 aLeft ventricular ejection fraction assessment in older adults an c2011 Sep 27 a1497-5060 v583 a

OBJECTIVES: The goal of this paper was to determine whether assessment of left ventricular ejection fraction (LVEF) enhances prediction of new-onset heart failure (HF) and cardiovascular mortality over and above N-terminal pro-B-type natriuretic peptide (NT-proBNP) level in older adults.

BACKGROUND: Elevated NT-proBNP levels are common in older adults and are associated with increased risk of HF.

METHODS: NT-proBNP and LVEF were measured in 4,137 older adults free of HF. Repeat measures of NT-proBNP were performed 2 to 3 years later and echocardiography was repeated 5 years later (n = 2,375), with a median follow-up of 10.7 years. The addition of an abnormal (<55%) LVEF (n = 317 [7.7%]) to initially elevated or rising NT-proBNP levels was evaluated to determine risk of HF or cardiovascular mortality. Changes in NT-proBNP levels were also assessed for estimating the risk of conversion from a normal to abnormal LVEF.

RESULTS: For participants with a low baseline NT-proBNP level (<190 pg/ml; n = 2,918), addition of an abnormal LVEF did not improve the estimation of risk of HF and identified a moderate increase in adjusted risk for cardiovascular mortality (hazard ratio: 1.69 [95% confidence interval: 1.22 to 2.31]). Among those whose NT-proBNP subsequently increased ≥25% to ≥190 pg/ml, an abnormal LVEF was likewise associated with an increased risk of cardiovascular mortality but not HF. Participants with an initially high NT-proBNP level (≥190 pg/ml) were at greater risk overall for both outcomes, and those with an abnormal LVEF were at the highest risk. However, an abnormal LVEF did not improve model classification or risk stratification for either endpoint when added to demographic factors and change in NT-proBNP. An initially elevated NT-proBNP or rising level was associated with an increased risk of developing an abnormal LVEF.

CONCLUSIONS: Assessment of LVEF in HF-free older adults based on NT-proBNP levels should be considered on an individual basis, as such assessments do not routinely improve prognostication.

10aAge Factors10aAged10aAged, 80 and over10aBiomarkers10aCohort Studies10aDeath10aFemale10aFollow-Up Studies10aHeart Failure10aHumans10aMale10aNatriuretic Peptide, Brain10aPeptide Fragments10aProspective Studies10aRisk Factors10aStroke Volume10aSurvival Rate10aVentricular Function, Left1 adeFilippi, Christopher, R1 aChristenson, Robert, H1 aKop, Willem, J1 aGottdiener, John, S1 aZhan, Min1 aSeliger, Stephen, L uhttps://chs-nhlbi.org/node/1330