Abstract 18668: ECG and proBNP are Markers of Different Subclinical Cardiac Impairment and Combined Improve Risk Assessment
Introduction: The ECG and proBNP are widely used markers of subclinical cardiac injury and can be used to predict future cardiovascular disease (CVD). However, It is unknown whether they are markers of the same underlying pathology or whether they independently identify high risk persons.
Hypothesis: To test if ECG changes and proBNP are independent predictors of CVD and if the combination will provide improved risk prediction in patients without known heart disease.
Methods: Pro-BNP and ECG was obtained on 5,539 persons from the 4th round of the Copenhagen City Heart Study. Persons with known heart disease were excluded. Median follow-up was 10.4 years. High proBNP levels were defined as the highest quartile of age and gender adjusted levels of pro-BNP. The ECGs were coded according to the Minnesota Code and ECG changes included Q-waves, ST-segment and T-wave changes, left ventricular hypertrophy and bundle branch block. The end-point was the combination of admission with ischemic heart disease, heart failure or CVD death.
Results: In all, 1,365 had high levels of proBNP and ECG changes were present in 907 persons. Kaplan-Meier curves of the combination of proBNP and ECG changes are shown in figure 1. In a fully adjusted Cox regression model both high proBNP and ECG changes remained significant predictors of CVD (low proBNP, ECG changes: HR: 1.56 (1.30-1.88); P<0.001, high proBNP, no ECG changes: HR: 1.91 (1.44-2.53); P<0.001, and both ECG changes and high proBNP: HR 3.83(2.92-5.02); P<0.001. Adding the combination of proBNP and ECG changes to a fully adjusted Cox model improved C-index from 0.819 to 0.831; P<0.001 and correctly reclassified 48.4%(40.3-56.6);P<0.001 on the continuous net reclassification scale.
Conclusion: According to our data, ECG changes and increased levels of proBNP are markers of different underlying pathology and adding the combination improves risk prediction in patients without known heart disease.
Author Disclosures: P.G. Jørgensen: None. J.S. Jensen: None. G.B. Jensen: None. M. Appleyard: None. R. Mogelvang: None.
- © 2014 by American Heart Association, Inc.