TY - JOUR
T1 - Risk scores versus natriuretic peptides for identifying prevalent stage B heart failure
AU - Gupta, Sachin
AU - Rohatgi, Anand
AU - Ayers, Colby R.
AU - Patel, Parag C.
AU - Matulevicius, Susan A.
AU - Peshock, Ronald M.
AU - Markham, David W.
AU - De Lemos, James A.
AU - Berry, Jarett D.
AU - Drazner, Mark H.
N1 - Funding Information:
The DHS was funded by the Donald W. Reynolds Foundation (Las Vegas, NV). Dr de Lemos has received grant from Biosite and Roche Diagnostics and consulting fees from Biosite and Ortho Clinical Diagnostics. Dr Berry receives funding from the Dedman Family Scholar in Clinical Care endowment at University of Texas Southwestern Medical Center; grant K23 HL092229 from the National Heart, Lung, and Blood Institute ; and grant 10BG1A4280091 from the American Heart Association. Dr Berry has also received a speaker's fees from Merck/Schering-Plough. Dr Drazner is supported by the James M. Wooten Chair in Cardiology at University of Texas Southwestern. The authors are solely responsible for the design and conduct of this study, all study analyses, the drafting and editing of the manuscript, and its final contents.
PY - 2011/5
Y1 - 2011/5
N2 - Background: 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. Methods: 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. Results: 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). Conclusions: 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.
AB - Background: 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. Methods: 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. Results: 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). Conclusions: 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.
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U2 - 10.1016/j.ahj.2011.01.007
DO - 10.1016/j.ahj.2011.01.007
M3 - Article
C2 - 21570524
AN - SCOPUS:79955897103
SN - 0002-8703
VL - 161
SP - 923-930.e2
JO - American heart journal
JF - American heart journal
IS - 5
ER -