03480nas a2200361 4500008004100000022001400041245013000055210006900185260001300254300001100267490000600278520240800284653000902692653001502701653001702716653002102733653001102754653001802765653001102783653000902794653003102803653002202834653000902856653002002865653003102885100003102916700003102947700003002978700002403008700001803032710003203050856003603082 2012 eng d a1876-759100aEchocardiography, natriuretic peptides, and risk for incident heart failure in older adults: the Cardiovascular Health Study.0 aEchocardiography natriuretic peptides and risk for incident hear c2012 Feb a131-400 v53 a

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 ± 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.

10aAged10aBiomarkers10aCardiomegaly10aEchocardiography10aFemale10aHeart Failure10aHumans10aMale10aNatriuretic Peptide, Brain10aPeptide Fragments10aRisk10aRisk Assessment10aVentricular Function, Left1 aKalogeropoulos, Andreas, P1 aGeorgiopoulou, Vasiliki, V1 adeFilippi, Christopher, R1 aGottdiener, John, S1 aButler, Javed1 aCardiovascular Health Study uhttps://chs-nhlbi.org/node/1365