Dataset Information

Reclassification of Pre-Heart Failure Stages Using Cardiac Biomarkers: The ARIC Study.

ABSTRACT:

Background

The recent heart failure (HF) guideline recommends the inclusion of cardiac biomarkers in defining Stage B HF.

Objectives

The authors evaluated the impact of incorporating cardiac biomarkers to reclassify HF in 5,324 participants (mean age: 75.8 years) without prevalent HF enrolled in the ARIC (Atherosclerosis Risk In Communities) study and assessed prognosis of Stage B using cardiac biomarkers.

Methods

Using N-terminal pro-B-type natriuretic peptide (<125 pg/mL or ≥125 pg/mL), high-sensitivity troponin T (<14 ng/L or ≥14 ng/L), and abnormal cardiac structure/function by echocardiography, individuals were classified as Stage A_new and Stage B_new HF, respectively. Stage B_new was further evaluated as elevated biomarker only, abnormal echocardiogram only, and abnormalities in both (echo + biomarker). The authors assessed risk for incident HF and all-cause death using Cox regression.

Results

Overall, 4,326 (81.3%) individuals were classified as Stage B_new with 1,123 (21.1%) meeting criteria for elevated biomarkers only. Compared with Stage A_new, Stage B_new was associated with increased risk for incident HF (HR: 3.70 [95% CI: 2.58-5.30]) and death (HR: 1.94 [95% CI: 1.53-2.46]). Stage B_{biomarkers only} and Stage B_{echo only} were associated with increased HF risk, whereas Stage B_{biomarkers only} was also associated with increased death. Stage B_{echo+biomarker} had the highest risk for HF (HR: 6.34 [95% CI: 4.37-9.19]) and death (HR: 2.53 [95% CI: 1.98-3.23]).

Conclusions

Incorporating biomarkers based on the new HF guideline reclassified approximately 1 in 5 older adults without prevalent HF to Stage B. The routine measurement of biomarkers can help to identify individuals at higher HF risk who may benefit most from HF prevention efforts.

SUBMITTER: Jia X

PROVIDER: S-EPMC10248756 | biostudies-literature | 2023 Apr

REPOSITORIES: biostudies-literature

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Publications

Reclassification of Pre-Heart Failure Stages Using Cardiac Biomarkers: The ARIC Study.

Jia Xiaoming X Al Rifai Mahmoud M Ndumele Chiadi E CE Virani Salim S SS de Lemos James A JA Lee Emmanuel E Shah Amil M AM Echouffo-Tcheugui Justin B JB Bozkurt Biykem B Hoogeveen Ron R Selvin Elizabeth E Ballantyne Christie M CM Nambi Vijay V

JACC. Heart failure 20230201 4

<h4>Background</h4>The recent heart failure (HF) guideline recommends the inclusion of cardiac biomarkers in defining Stage B HF.<h4>Objectives</h4>The authors evaluated the impact of incorporating cardiac biomarkers to reclassify HF in 5,324 participants (mean age: 75.8 years) without prevalent HF enrolled in the ARIC (Atherosclerosis Risk In Communities) study and assessed prognosis of Stage B using cardiac biomarkers.<h4>Methods</h4>Using N-terminal pro-B-type natriuretic peptide (<125 pg/mL ...[more]

PMID: 36881398

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Project description:Background Pulmonary and cardiac functions decline with age, but the associations of pulmonary dysfunction with cardiac function and heart failure (HF) risk in late life is not known. We aimed to determine the associations of percent predicted forced vital capacity (ppFVC) and the ratio of forced expired volume in 1 second (FEV1) to forced vital capacity (FVC; FEV1/FVC) with cardiac function and incident HF with preserved or reduced ejection fraction in late life. Methods and Results Among 3854 HF-free participants in the ARIC (Atherosclerosis Risk in Communities) cohort study who underwent echocardiography and spirometry at the fifth study visit (2011-2013), associations of FEV1/FVC and ppFVC with echocardiographic measures, cardiac biomarkers, and risk of HF, HF with preserved ejection fraction, and HF with reduced ejection fraction were assessed. Multivariable linear and Cox regression models adjusted for demographics, body mass index, coronary disease, atrial fibrillation, hypertension, and diabetes. Mean age was 75±5 years, 40% were men, 19% were Black, and 61% were ever smokers. Mean FEV1/FVC was 72±8%, and ppFVC was 98±17%. In adjusted analyses, lower FEV1/FVC and ppFVC were associated with higher NT-proBNP (N-terminal pro-B-type natriuretic peptide; both P<0.001) and pulmonary artery pressure (P<0.004). Lower ppFVC was also associated with higher left ventricular mass, left ventricular filling pressure, and high-sensitivity C-reactive protein (all P<0.01). Lower FEV1/FVC was associated with a trend toward higher risk of incident HF with preserved ejection fraction (hazard ratio [HR] per 10-point decrease, 1.31; 95% CI, 0.98-1.74; P=0.07) and HF with reduced ejection fraction (HR per 10-point decrease, 1.24; 95% CI, 0.91-1.70; P=0.18), but these associations did not reach statistical significance. Lower ppFVC was associated with incident HF with preserved ejection fraction (HR per 10-unit decrease, 1.21; 95% CI, 1.04-1.41; P=0.013) but not with HF with reduced ejection fraction (HR per 10-unit decrease, 0.90; 95% CI, 0.76-1.07; P=0.24). Conclusions Subclinical reductions in FEV1/FVC and ppFVC differentially associate with cardiac function and HF risk in late life.

Dataset Information

Reclassification of Pre-Heart Failure Stages Using Cardiac Biomarkers: The ARIC Study.

Background

Objectives

Methods

Results

Conclusions

Publications

Reclassification of Pre-Heart Failure Stages Using Cardiac Biomarkers: The ARIC Study.

Similar Datasets

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