Abstract 3109: Relationship of N terminal-proB Natriuretic Peptide to Asymptomatic Left Ventricular Dysfunction in a Population at High Risk for Heart Failure
PURPOSE: Improvement of quality of life and survival in patients with treated chronic heart failure (HF) and left ventricular systolic dysfunction is well documented. Early diagnosis, facilitating early treatment and prevention of progression to heart failure, remains a challenge.
METHOD: SCREEN HF will assess the prevalence of left ventricular dysfunction in a high risk (>60years plus ≥1 HF risk factor) population (n=3,500) without a previous diagnosis of HF or left ventricular dysfunction. Following initial screening, 700 participants with NT-proB natriuretic peptide (NT-proBNP) in the highest quintile and a subgroup of 50 consecutive participants in the lowest quintile are invited to undergo assessment of cardiac structure and function by ECG and echocardiogram.
RESULTS: To date, 1117 participants have been screened and 203 (top quintile; NT-proBNP> 31.7pmol/L) and 20 (low quintile; NT-proBNP <5.7pmol/L) have completed echocardiography. Subjects in the highest NT-proBNP quintile (median 51pmol/L, IQR40–91pmol/L) when compared to the lowest four quintiles (median 10pmol/L, IQR6 –17pmol/L), were older (73.9±7.1 vs. 69.2±6.0years, p<0.00001) and more likely to have a history of ischaemic heart disease (25 vs.14%, OR2, 95% CI:1.5–3.1, p=0.0001). Diastolic dysfunction, in the top NT-proBNP quintile, was present in 77%, and this was moderate or severe in 35% (95%CI:33–53%) [subjects with AF or paced rhythm were excluded]. Mild diastolic dysfunction was present in 60% of the lowest NT-proBNP quintile; there was no moderate or severe diastolic dysfunction in this group. Mean left ventricular ejection fraction (Simpson’s biplane) was significantly reduced in the highest compared to lowest NT-proBNP quintile (52 ± 9.1% vs. 58± 6.3%, p=0.01). Moderate or severe systolic dysfunction (LVEF<40%) was present in 7% (95%CI:4 –13%) of the cohort, all in the highest quintile.
CONCLUSION: This population with heart failure risk factors and elevated NT-proBNP had a large burden of asymptomatic ventricular dysfunction. This was particular the case for diastolic dysfunction which is also associated with increased morbidity and mortality. This suggests a combined NT-proBNP testing in a population with HF risk factors may be an effective approach to screening.