Risk scores versus natriuretic peptides for identifying prevalent stage B heart failure

• Published in: The American heart journal Vol. 161; no. 5; pp. 923 - 930.e2
• Main Authors: Gupta, Sachin, Rohatgi, Anand, Ayers, Colby R., Patel, Parag C., Matulevicius, Susan A., Peshock, Ronald M., Markham, David W., de Lemos, James A., Berry, Jarett D., Drazner, Mark H.
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.05.2011; Mosby; Elsevier Limited
• Subjects: Adult; Aged; Biological and medical sciences; Cardiology; Cardiology. Vascular system; Cardiovascular; Cardiovascular disease; Drug therapy; Female; Follow-Up Studies; Heart; Heart attacks; Heart Failure - blood; Heart Failure - epidemiology; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Humans; Male; Medical sciences; Middle Aged; Natriuretic Peptides - blood; Prevalence; Prospective Studies; Risk Assessment - methods; Risk Factors; Severity of Illness Index; United States - epidemiology; Womens health; United States; Heart failure; Prevalence; Peptides; Heart disease; Risk factor; Cardiovascular disease; Risk; Circulatory system; Cardiology; Epidemiology; Comparative study
• DOI: 10.1016/j.ahj.2011.01.007
• ISSN: 0002-8703; 1097-6744

Identifying asymptomatic individuals with American Heart Association/American College of Cardiology stage B heart failure (HF) in the population is an important step to prevent the development of symptomatic HF. The comparative utility of 2 screening strategies (biomarkers vs risk scores) in identifying prevalent stage B HF is unknown. Participants 30 to 65 years old without symptomatic HF in the Dallas Heart Study who had a cardiac magnetic resonance imaging were included (n = 2,277). Stage B HF (n = 284) was defined by left ventricular (LV) hypertrophy, reduced LV ejection fraction, or prior myocardial infarction. We compared the utility of 2 risk scores (Health Aging and Body Composition HF risk score and the Framingham Heart Failure risk score) with B-type natriuretic peptide (BNP) and N-terminal pro-BNP in identifying stage B HF using logistic regression. Depending upon the method of indexing LV mass (body surface area, fat-free mass, or height 2.7), the c-statistic for the Health Aging and Body Composition HF risk score (0.73, 0.75, and 0.64, respectively) was greater than that for BNP (0.62, 0.70, and 0.57, respectively) and N-terminal pro-BNP (0.62, 0.69, and 0.56, respectively) ( P < .01 for all). These findings were similar for the Framingham Heart Failure risk score except when LV mass was indexed to fat-free mass. Addition of natriuretic peptide levels to the risk scores resulted in a modest but significant improvement in discrimination of stage B HF (Δ c-statistic, 0.01-0.03, P < .05 for all). Screening for stage B HF in the population is enhanced when natriuretic peptides are measured in addition to, rather than in place of, traditional risk scores.