Open AccessAssociation of Novel Biomarkers of Cardiovascular Stress With Left Ventricular Hypertrophy and Dysfunction: Implications for Screening
Author(s) -
Xanthakis Vanessa,
Larson Martin G.,
Wollert Kai C.,
Aragam Jayashri,
Cheng Susan,
Ho Jennifer,
Coglianese Erin,
Levy Daniel,
Colucci Wilson S.,
Michael Felker G.,
Benjamin Emelia J.,
Januzzi James L.,
Wang Thomas J.,
Vasan Ramachandran S.
Publication year - 2013
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.113.000399
Subject(s) - medicine , cardiology , gdf15 , ejection fraction , left ventricular hypertrophy , natriuretic peptide , biomarker , heart failure , brain natriuretic peptide , odds ratio , troponin i , logistic regression , troponin , blood pressure , myocardial infarction , biochemistry , chemistry
Background Currently available screening tools for left ventricular ( LV ) hypertrophy ( LVH ) and systolic dysfunction ( LVSD ) are either expensive (echocardiography) or perform suboptimally (B‐type natriuretic peptide [ BNP ]). It is unknown whether newer biomarkers are associated with LVH and LVSD and can serve as screening tools. Methods and Results We studied 2460 F ramingham Study participants (mean age 58 years, 57% women) with measurements of biomarkers mirroring cardiac biomechanical stress (soluble ST ‐2 [ ST 2], growth differentiation factor‐15 [ GDF ‐15] and high‐sensitivity troponin I [hsTnI]) and BNP . We defined LVH as LV mass/height 2 ≥the sex‐specific 80th percentile and LVSD as mild/greater impairment of LV ejection fraction ( LVEF ) or a fractional shortening <0.29. Adjusting for standard risk factors in logistic models, BNP , GDF ‐15, and hsTnI were associated with the composite echocardiographic outcome ( LVH or LVSD ), odds ratios ( OR ) per SD increment in log‐biomarker 1.29, 1.14, and 1.18 (95% CI : 1.15 to 1.44, 1.004 to 1.28, and 1.06 to 1.31), respectively. The C‐statistic for the composite outcome increased from 0.765 with risk factors to 0.770 adding BNP , to 0.774 adding novel biomarkers. The continuous Net Reclassification Improvement was 0.212 (95% CI : 0.119 to 0.305, P <0.0001) after adding the novel biomarkers to risk factors plus BNP . BNP was associated with LVH and LVSD in multivariable models, whereas GDF ‐15 was associated with LVSD ( OR 1.41, 95% CI : 1.16 to 1.70), and hsTnI with LVH ( OR 1.22, 95% CI : 1.09 to 1.36). ST 2 was not significantly associated with any outcome. Conclusions Our community‐based investigation suggests that cardiac stress biomarkers are associated with LVH and LVSD but may have limited clinical utility as screening tools.