Abstract 14087: B-Type Natriuretic Peptide Identifies Silent Cardiac Target Organ Damage in Asymptomatic Primary Prevention Patients
Background: Identification of individuals with target organ damage (TOD) at risk of cardiovascular events is important for the optimal use of primary interventions. B-type natriuretic peptide (BNP) has been shown to predict cardiovascular morality in a wide range of cardiac conditions.
Hypothesis: We hypothesized that BNP can be used to identify pan-cardiac TOD (left ventricular hypertrophy (LVH), systolic dysfunction (LVSD), diastolic dysfunction (LVDD), left atrial enlargement (LAE) or ischemia) in a population of asymptomatic individuals considered for primary preventive therapy.
Methods: We prospectively recruited 300 asymptomatic individuals without heart failure considered for primary preventive therapy based on traditional cardiovascular risk factors. Patients with valvular heart diasease, atrial fibrillation and renal impairment were excluded. Each participant underwent a comprehensive echocardiographic examination, as per the American Society of Echocardiography guidelines, for the assessment of LV mass, LV systolic and diastolic function, and left atrial volume. Presence of inducible ischemia was assessed by dobutamine stress echocardiography or dypridamole myocardial perfusion imaging. Participants were divided into 3 groups based on BNP terciles and the prevalence of various TOD in each group was compared. We also constructed a ROC curve for BNP and its ability to detect presence of any of the TOD (LVH, LVSD, LVDD, LAE or Ischemia).
Results: Out of 300 participants (Mean age 64±6.1, 58% males) 111 (37%) had evidence of cardiac TOD (33% LVH, 18.9% LAE, 18.6%LVDD, 7.3% LVSD and 6.3% Ischemia.) 42% of participants in the top BNP tercile (BNP > 20 pg/ml) had TOD compared to 11% in the bottom BNP tercile (BNP <10pg/ml) Area under the ROC curve for BNP to detect any form of TOD was 0.77 (95%CI 0.69-0.82). Prevalence of each cardiac TOD gradually increased from the bottom BNP tercile to the top BNP tercile. LVH, LAE and LVDD were the main driving factors behind a raised BNP.
Conclusion: In a randomly selected cohort of asymptomatic patients requiring primary prevention, a raised BNP identifies existing silent cardiac TOD of various subtypes. Using BNP to identify silent cardiac TOD could, in the future, be harnessed to improve primary prevention.
- © 2010 by American Heart Association, Inc.