Exploratory Analysis of Low PEACE Heart Failure Risk Score with Elevated NTproBNP: Insights from the MESA Study

Abstract

Introduction PEACE heart failure (HF) score is a validated risk prediction score exclusive of NTproBNP. NTproBNP is a sensitive but non-specific biomarker with independent prognostic value for incident HF. We explore discordance between the two using data from the MESA study which enrolled patients devoid of existing cardio-cerebro-vascular disease. Hypothesis Patients with low risk PEACE score but elevated NTproBNP levels would be at elevated risk for incident HF. Methods PEACE HF score was calculated for visit 1 of the MESA study. NTproBNP > 125 pg/mL and eGFR Results 3,294 patients had low PEACE HF score, of which 484 had elevated NTproBNP. Elevated NTproBNP group was older with higher prevalence of hypertension, higher ejection fraction and comparable left ventricle mass index. KM curves showed higher incident HF in the elevated NTproBNP group. NTproBNP retained its incremental value after adjusting for age, race and gender (HR 9.2 [4.9-17.6]) (p Conclusion Among an ambulatory population free of clinical cardio-cerebrovascular disease and preserved renal function, 14% of patients at low risk of incident HF calculated using PEACE HF score had elevated NTproBNP levels which translated to higher risk of incident HF. Cost analysis studies are needed to assess its viability in risk assessment in low-risk PEACE patients.