N‐terminal B‐type natriuretic peptide and the association with left ventricular diastolic function in a population at high risk of incident heart failure: results of the SCReening Evaluation of the Evolution of New‐Heart Failure Study (SCREEN‐HF)

Aims Impaired diastolic function is associated with increased morbidity and mortality, but antecedents and predictors of progression to heart failure (HF) are not well understood. We examined associations between NT‐proBNP, HF risk factors, and diastolic function in a population at high risk for incident HF. Methods and results A total of 3550 subjects at high risk for incident HF (≥60 years plus ≥1 HF risk factor), but without pre‐existing HF or LV dysfunction were recruited. Participants at highest risk ( n = 664) (NT‐proBNP in the highest quintile >254 pg/mL) underwent echocardiography. Moderate or severe diastolic dysfunction was observed in 25% [95% confidence interval (CI) 21–29%] of participants. Age ( P = 0.001), male gender ( P = 0.03), diabetes ( P = 0.03), and NT‐proBNP ( P = 0.002) were associated with severity of diastolic dysfunction after adjustment for HF risk factors and LVEF. In regression analysis, log‐transformed NT‐proBNP was also associated with LV mass index ( P = 0.05), left atrial size ( P < 0.0001), and Doppler ratio of the mitral valve E/e' ( P = 0.001). Multiple HF risk factors were present in the majority of participants (>70%), but no association was observed between diastolic dysfunction and the number of risk factors reported ( P = 0.3). Conclusion Diastolic dysfunction was observed in one in four of these high risk subjects (≥ 60 years, HF risk factor, NT‐proBNP >254 pg/mL). NT‐proBNP, age and diabetes were strongly associated with severity of diastolic dysfunction, whereas other HF risk factors and LVEF were not. More targeted surveillance using a combination of risk factors and biomarkers may improve identification of those at great risk of incident HF.