Abstract 12695: Multimodality Risk Assessment in the General Population
Background: Few studies have combined biomarkers, imaging, and ECG for risk assessment in the general population.
Methods: We included 2215 participants from the Dallas Heart Study who were free from CVD at baseline and had measurement of coronary calcium (CAC) by CT, ECG-LVH, NT-proBNP and high sensitivity cTnT (hs-cTnT). Abnormal screening cutpoints were prospectively defined as CAC > 10 Agatston units, LVH by Cornell criteria, NT-proBNP >75th %ile for age/sex, and hs-cTnT ≥ 3 ng/L. A composite CVD outcome was prospectively defined as CV death, MI, stroke, coronary or peripheral revascularization, admission for CHF, and atrial fibrillation. Associations of test results with the composite CVD outcome were assessed in Cox models adjusting for traditional risk factors, hs-CRP, and eGFR.
Results: The median age of participants was 45, with 56% female and 47% African American, and a median FRS estimated 10 year CVD risk of 4.5%. CAC >10 was present in 19%, ECG-LVH in 9%, ↑NT-proBNP in 24% and ↑hs-cTnT in 24%. Over a mean f/u of 8 years, 157 primary CV events occurred. In the fully adjusted model, each abnormal test result was independently associated with incident CVD, even after accounting for the other test
Results: CAC> 10 HR 1.8 [95% CI 1.3-2.7], ↑NT-proBNP HR 1.9 [1.4-2.7], ↑hs-cTnT HR 1.7 [1.2-2.5], ECG-LVH 2.1 [1.4-3.1]. No association with CVD was observed for hs-CRP. Using a simple integer score counting the number of abnormal screening test results, a robust stepwise increase in CVD risk was observed (Figure, left). This pattern was mirrored in a subgroup of 1689 individuals estimated to be at low (≤10%) 10- year CVD risk (Figure, right). Addition of the integer score to the fully adjusted model improved the c-statistic from 0.818 to 0.844 (p≤0.01)
Conclusions: Multi-modality CVD risk assessment using CAC, ECG-LVH, NT-proBNP and hs- cTnT significantly improves risk estimation, including in low risk individuals, and can be applied in a relatively simple clinical strategy.
- © 2013 by American Heart Association, Inc.