Abstract MP05: Screening for Left Ventricular Dysfunction and Hypertrophy with Novel Biomarkers of Cardiovascular Stress
Background. Heart failure is typically preceded by asymptomatic abnormalities of cardiac structure or function, including left ventricular systolic dysfunction (LVSD) and left ventricular hypertrophy (LVH). Currently available screening tools for LVSD and LVH are either expensive (echocardiography) or perform sub-optimally (B-Type natriuretic peptide [BNP]). We tested the hypothesis that newer biomarkers of cardiac stress are more effective screening tools.
Methods and Results. We studied 2,460 Framingham Study participants (mean age 58 years, 57% women) attending a routine examination who had measurements of cardiac stress biomarkers (soluble ST-2 [ST2], growth differentiation factor 15 [GDF-15] and high sensitivity troponin I [hsTnI]) and BNP, and underwent echocardiography. LVSD was defined as mild/greater degree of impairment of LV ejection fraction [LVEF] or fractional shortening <0.29. LVH was defined as LV mass/(height)2 ≥the sex-specific 80th percentile. Adjusting for clinical risk factors, BNP, GDF15, and hsTnI were associated with the presence of the composite outcome (LVSD or LVH, odds ratios [OR] 1.33, 1.38, and 1.25 [95% CI: 1.17-1.51, 1.01-1.90, and 1.09-1.44], respectively, per 1-unit increase in log-biomarker). The C-statistic increased from 0.765 (model with only risk factors) to 0.774 upon adding novel biomarkers (p=0.03, Figure). BNP was associated with both LVSD and LVH in multivariable models, whereas GDF15 was associated with LVSD (OR 2.39 95% CI: 1.48-3.87), and hsTnI was associated with LVH (OR 1.31, 95% CI: 1.12-1.52). Adding the biomarkers to clinical risk factors within high-risk subgroups (individuals ≥65 years, those with hypertension) produced statistically significant but modest increments in C-statistic (from 0.737 to 0.756 [p=0.04], and 0.714 to 0.736 [p=0.02], respectively). ST2 was not associated with any outcome.
Conclusions. In our large community-based sample, GDF-15, hsTnI and BNP led to modest improvements over clinical risk factors for screening for LVSD & LVH.
- © 2013 by American Heart Association, Inc.