Abstract 13711: Incident Heart Failure Risk Stratification with Clinical Risk Factors, Natriuretic Peptides, and Echocardiography: The Cardiovascular Health Study
Background: NT-proBNP and echocardiography have suboptimal test characteristics for population-wide heart failure (HF) risk stratification in older adults. We examined the utility of these tools for HF risk stratification in concert with a validated clinical risk score.
Methods: We evaluated the improvement in 5-yr HF risk prediction offered by adding NT-proBNP levels, an echocardiographic score, or both (simultaneously and sequentially) to the clinical Health ABC HF Risk Score in 3752 participants of the Cardiovascular Health Study (age 72.6±5.4 yrs; 40.8% men; 86.5% white) without HF at baseline. To identify independent echocardiographic predictors, we used the Health ABC HF Risk Score as a covariate in proportional hazards models. To evaluate improvement in model performance, we assessed changes in the Bayesian information criterion (BIC) and C index, integrated discrimination improvement, and net reclassification improvement. We also repeated the analyses in a subset of 2538 participants with quantitative left ventricular (LV) measurements available.
Results: Reduced LV ejection fraction, abnormal E/A ratio, enlarged left atrium, and increased LV mass, were all independent echocardiographic predictors of HF. Adding NT-proBNP levels and echocardiographic score (the weighted sum of echocardiographic predictors) to the base model improved BIC and C index and led to robust improvements in integrated discrimination and net reclassification (Table 1); combined use had an additive effect. Quantitative assessment of LV further strengthened the value of echocardiography. Reclassification was mostly confined to intermediate risk (5% to 20% 5-yr HF risk) participants. Echocardiography yielded modest reclassification when used sequentially after NT-proBNP.
Conclusions: In older adults, NT-proBNP and echocardiography offer significant HF risk reclassification over a clinical prediction model, especially for intermediate risk individuals.
- © 2011 by American Heart Association, Inc.