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Older Adults, "Malignant" Left Ventricular Hypertrophy, and Associated Cardiac-Specific Biomarker Phenotypes to Identify the Differential Risk of New-Onset Reduced Versus Preserved Ejection Fraction Heart Failure: CHS (Cardiovascular Health Study).
Thursday,2015-06-11 09:50 America/Los_Angeles — zdrager
| Title | Older Adults, "Malignant" Left Ventricular Hypertrophy, and Associated Cardiac-Specific Biomarker Phenotypes to Identify the Differential Risk of New-Onset Reduced Versus Preserved Ejection Fraction Heart Failure: CHS (Cardiovascular Health Study). |
| Publication Type | Journal Article |
| Year of Publication | 2015 |
| Authors | Seliger, SL, de Lemos, J, Neeland, IJ, Christenson, R, Gottdiener, J, Drazner, MH, Berry, J, Sorkin, J, DeFilippi, C |
| Journal | JACC Heart Fail |
| Volume | 3 |
| Issue | 6 |
| Pagination | 445-55 |
| Date Published | 2015 Jun |
| ISSN | 2213-1787 |
| Keywords | Aged, Biomarkers, Echocardiography, Female, Heart Failure, Humans, Hypertrophy, Left Ventricular, Male, Natriuretic Peptide, Brain, Peptide Fragments, Phenotype, Prospective Studies, Risk Factors, Troponin T |
| Abstract | <p><b>OBJECTIVES: </b>This study hypothesized that biomarkers of subclinical myocardial injury (high-sensitivity cardiac troponin T [hs-cTnT]) and hemodynamic stress (N-terminal pro-B-type natriuretic peptide [NT-proBNP]) would differentiate heart failure (HF) risk among older adults with left ventricular hypertrophy (LVH).</p><p><b>BACKGROUND: </b>The natural history of LVH, an important risk factor for HF, is heterogeneous.</p><p><b>METHODS: </b>NT-proBNP and hs-cTnT were measured at baseline and after 2 to 3 years in older adults without prior HF or myocardial infarction in the CHS (Cardiovascular Health Study). LVH and left ventricular ejection fraction were determined by echocardiography. HF events were adjudicated over a median of 13.1 years and classified as preserved or reduced left ventricular ejection fraction (heart failure with preserved ejection fraction or heart failure with reduced ejection fraction [HFrEF]). Adjusted risk of HF by LVH and biomarker tertiles, and by LVH and longitudinal increase in each biomarker was estimated using Cox regression.</p><p><b>RESULTS: </b>Prevalence of LVH was 12.5% among 2,347 participants with complete measures. Adjusted risk of HF (N = 643 events) was approximately 3.8-fold higher among participants with LVH and in the highest biomarker tertile, compared with those with low biomarker levels without LVH (NT-proBNP, hazard ratio [HR]: 3.78; 95% confidence interval [CI]: 2.78 to 5.15 and hs-cTnT, HR: 3.86; 95% CI: 2.84 to 5.26). The adjusted risk of HFrEF was 7.8 times higher among those with the highest tertile of hs-cTnT and LVH (HR: 7.83; 95% CI: 4.43 to 13.83). Those with LVH and longitudinal increases in hs-cTnT or NT-proBNP were approximately 3-fold more likely to develop HF, primarily HFrEF, compared with those without LVH and with stable biomarkers.</p><p><b>CONCLUSIONS: </b>The combination of LVH with greater hs-cTnT or NT-proBNP levels, and their longitudinal increase, identifies older adults at highest risk for symptomatic HF, especially HFrEF. These biomarkers may characterize sub-phenotypes in the transition from LVH to HF and suggest modifiable targets for prevention.</p> |
| DOI | 10.1016/j.jchf.2014.12.018 |
| Alternate Journal | JACC Heart Fail |
| PubMed ID | 25982111 |
| PubMed Central ID | PMC4458213 |
| Grant List | AG023629 / AG / NIA NIH HHS / United States HHSN268200800007C / HL / NHLBI NIH HHS / United States HHSN268201200036C / HL / NHLBI NIH HHS / United States HL080295 / HL / NHLBI NIH HHS / United States N01 HC085080 / HC / NHLBI NIH HHS / United States N01 HC085082 / HC / NHLBI NIH HHS / United States N01 HC085086 / HC / NHLBI NIH HHS / United States N01 HC55222 / HC / NHLBI NIH HHS / United States N01HC55222 / HL / NHLBI NIH HHS / United States N01HC85079 / HC / NHLBI NIH HHS / United States N01HC85079 / HL / NHLBI NIH HHS / United States N01HC85080 / HC / NHLBI NIH HHS / United States N01HC85081 / HC / NHLBI NIH HHS / United States N01HC85082 / HC / NHLBI NIH HHS / United States N01HC85082 / HL / NHLBI NIH HHS / United States N01HC85083 / HC / NHLBI NIH HHS / United States N01HC85083 / HL / NHLBI NIH HHS / United States N01HC85086 / HC / NHLBI NIH HHS / United States P30 AG028747 / AG / NIA NIH HHS / United States R01 HL080295 / HL / NHLBI NIH HHS / United States |