Abstract 14697: Left Ventricular Mass, Biomarkers of Myocardial Injury and Hemodynamic Stress, and Incident Heart Failure in Older Adults: The Cardiovascular Health Study
Background: Although LVH is an important risk factor for heart failure (HF), its natural history is heterogeneous. We hypothesized that biomarkers of subclinical myocardial injury (high sensitive cTnT (hs-cTnT])) and hemodynamic stress (NT-proBNP) would differentiate HF risk among older asymptomatic adults with LVH.
Methods: NT-proBNP and hs-cTnT were measured in older adults without prevalent HF or prior MI in the Cardiovascular Health Study (CHS). LV mass (LVM) was estimated by echo, and LVH was defined as observed/expected weight-adjusted LVM>1.45, based on normative values in CHS. HF events were adjudicated over a median 13.1 years. The risk of HF by LVH and age- & sex-stratified tertiles of each biomarker was estimated. The association of LVH and biomarker concentrations with incident HF was estimated using Cox regression, adjusting for demographics and traditional CV risk factors
Results: Among 2,347 participants (mean age 72) with measures of LVM and biomarkers, 294 (12.5%) had LVH. Rate of incident HF was greater among those with LVH and was further differentiated by concentrations of NT-proBNP or hs-cTnT (figure; p<.001 for both). Compared to those in the lowest biomarker tertile without LVH, those in the highest tertile of either biomarker with LVH had a 4-fold higher risk of HF (for NT-proBNP: adjusted HR= 4.00, 95% CI: 2.95, 5.43; for hs-cTnT: HR=4.01, 95%CI: 2.95, 5.44).
Conclusion: Greater hs-cTnT or NT-proBNP identify older adults with LVH who are at highest risk for transition to symptomatic HF. These biomarkers may help to identifiy pathways that contribute to the transition from LVH to clinical HF and to target HF prevention strategies to those most likely to benefit.
- © 2013 by American Heart Association, Inc.