Association of Elevated NT-proBNP With Myocardial Fibrosis in the Multi-Ethnic Study of Atherosclerosis (MESA)

Abstract

Background: Serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) is considered a marker that is expressed in response to myocardial strain and possibly fibrosis. However, the relationship to myocardial fibrosis in a community-based population is unknown.

Objectives: The authors evaluated the relationship between cardiac magnetic resonance (CMR) measures of fibrosis and NT-proBNP levels in the MESA (Multi-Ethnic Study of Atherosclerosis) study.

Methods: A total of 1,334 participants (52% white, 23% black, 11% Chinese, 14% Hispanic, and 52% men with a mean age of 67.6 years) at 6 sites had both serum NT-proBNP measurements and CMR with T1 mapping of indices of fibrosis at 1.5 T. Univariate and multivariable regression analyses adjusting for demographics, cardiovascular risk factors, and left ventricular (LV) mass were performed to examine the association of log NT-proBNP with CMR T1 mapping indices.

Results: In the fully adjusted model, each 1-SD increment (0.44 pg/ml) of log NT-proBNP was associated with a 0.62% increment in extracellular volume fraction (p < 0.001), 0.011 increment in partition coefficient (p < 0.001), and 4.7-ms increment in native T1 (p = 0.001). Results remained unchanged after excluding individuals with clinical cardiovascular disease or late gadolinium enhancement (n = 167), and after replacing LV mass by LV end-diastolic volume in the regression models.

Conclusions: Elevated NT-proBNP is related to subclinical fibrosis in a community-based setting. (Multi-Ethnic Study of Atherosclerosis [MESA]; NCT00005487).

Keywords: ECV; MR imaging; NT-proBNP; T1 mapping.

Published by Elsevier Inc.

Figures

FIGURE 1. Box Plot of Log NT-proBNP Across Quartiles of CMR ECV

Box plot showing the relationship between NT-proBNP and quartile of ECV. CMR = cardiac magnetic resonance; ECV = extracellular volume fraction; NT-proBNP = N-terminal pro–B-type natriuretic protein.

FIGURE 2. The Unadjusted Relationships Between Log NT-proBNP and T1 Indices

The relationships between log NT-proBNP and myocardial fibrosis assessed by CMR ECV (A), native T1 (B), and post-contrast T1 (C) at 12 min. Unadjusted linear regression demonstrated significant positive correlation between log NT-proBNP and ECV as well as native T1 (p

CENTRAL ILLUSTRATION. Association of NT-proBNP With CMR-Measured ECV

(Left) Cardiovascular risk factors ultimately result in myocardial remodeling and increased myocardial wall stress. In response, cardiac natriuretic peptides are secreted and are detected in the serum. Myocardial remodeling and wall stress will also result in expansion of the extracellular matrix and collagen deposition. (Right) In the MESA (Multi-Ethnic Study of Atherosclerosis) population, greater levels of NT-proBNP are associated with greater ECV. Regression estimates based on the fully adjusted models are shown. CMR = cardiac magnetic resonance; ECV = extracellular volume fraction; LV = left ventricular; NT-proBNP = N-terminal pro–B-type natriuretic protein.