N-terminal pro-B-type natriuretic peptide, left ventricular mass, and incident heart failure: Multi-Ethnic Study of Atherosclerosis

Abstract

Background: Elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) is associated with clinically overt heart failure (HF). However, whether it provides additive prognostic information for incident HF beyond traditional risk factors and left ventricular (LV) mass index among multi-ethnic asymptomatic individuals has not yet been determined. We studied the associations of plasma NT-proBNP and magnetic resonance imaging defined LV mass index with incident HF in an asymptomatic multi-ethnic population.

Methods and results: A total of 5597 multi-ethnic participants without clinically apparent cardiovascular disease underwent baseline measurement of NT-proBNP and were followed for 5.5±1.1 years. Among them, 4163 also underwent baseline cardiac magnetic resonance imaging. During follow-up, 111 participants experienced incident HF. Higher NT-proBNP was significantly associated with incident HF, independent of baseline age, sex, ethnicity, systolic blood pressure, diabetes mellitus, smoking, estimated glomerular filtration rate, medications (anti-hypertensive and statin), LV mass index, and interim myocardial infarction (hazard ratio: 1.95 per 1U log NT-proBNP increment, 95% CI 1.54-2.46, P<0.001). This relationship held among different ethnic groups, non-Hispanic whites, African-Americans, and Hispanics. Most importantly, NT-proBNP provided additive prognostic value beyond both traditional risk factors and LV mass index for predicting incident HF (integrated discrimination index=0.046, P<0.001; net reclassification index; 6-year risk probability categorized by <3%, 3-10%, >10% =0.175, P=0.019; category-less net reclassification index=0.561, P<0.001).

Conclusions: Plasma NT-proBNP provides incremental prognostic information beyond traditional risk factors and the magnetic resonance imaging-determined LV mass index for incident symptomatic HF in an asymptomatic multi-ethnic population.

Clinical trial registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00005487.

Figures

Figure 1

Kaplan-Meier curves of unadjusted cumulative hazard of incident heart failure according to quartiles of N-terminal–pro B type natriuretic peptide in the entire study population (A) and each ethnicity group (B, C, D). CHF indicates congestive heart failure.

Figure 2

Additive prognostic value of NT-proBNP beyond traditional risk factors and LV mass index. A, NT-proBNP significantly improved receiver operating characteristic curve (ROC) area by 7% compared with traditional risk factors (covariates used in Model 2). B, NT-proBNP significantly improved ROC area by 4% compared with traditional risk factors combined with LVMI (Model 3). NT-proBNP indicates N-terminal–pro B type natriuretic peptide; LVMI, left ventricular mass index AUC, area under the curve.