N-terminal fragment of brain natriuretic peptide as a powerful and independent predictor of subclinical heart and vascular disease (stage B) in an asymptomatic population from the community screening

Abstract

NT-proBNP is associated with several indexes of cardiac and vascular subclinical disease, but its role in screening for asymptomatic cardiovascular involvement is still debated. 810 asymptomatic people without previous cardiovascular disease underwent laboratory assessment with NT-proBNP, echocardiography and CCS and CIMT evaluation by CT and neck echography, respectively. Asymptomatic cardiovascular involvement was defined by one among LVEF 15 and/or LV mass index >115 in men or >95 g/m2 in women, LV end diastolic diameter >55 mm, CCS >400AU or CIMT >0.9 mm. 31%, 10%, 6%, 5%, 25% and 8% of subjects presented LV hypertrophy, E/E' 55 mm, CIMT >0.9 mm and CCS >400 A.U., respectively. Subjects with at least one index of cardiovascular involvement (331, 40%) showed lower hemoglobin, BMI and eCrCl with higher 10 yrs. Framingham risk score and NT-proBNP (61; 34-103 vs. 37; 22-79 ng/L, p<0.01). NT-proBNP showed the highest area under the curve (AUC) for prediction of cardiac and/or vascular involvement (Figure 1). AUC for prediction of both heart and vascular involvement (0.692; 0.647-0.738) by NT-proBNP was significantly higher than AUC for separate prediction of cardiac (0.588; 0.591-0.634) or vascular (0.544; 0.480-0.609) involvement (p<0.01 for both comparisons). NT-proBNP was higher in subjects with both cardiac and vascular involvement. At multivariate analysis, with age and lower eCrCl, NT-proBNP (OR 1.977, 95% CI: 1.465-2.668, p<0.01) was an independent predictor of asymptomatic cardiovascular involvement. ![Figure][1] Figure 1 NT-proBNP predicts both cardiac and vascular subclinical involvement in an asymptomatic population, likely representing an important screening tool assessing global cardiovascular health. [1]: pending:yes