NT-PROBNP COMBINED WITH R WAVE IN AVL LEAD PREDICTS MORTALITY BETTER THAN ECHOCARDIOGRAPHIC LEFT VENTRICULAR MASS IN HYPERTENSION

Abstract

Objective: Plasma NT-proBNP and R wave in aVL lead (RaVL) have been associated with mortality in hypertensive patients. The aim of the present study was to test the prognostic value of their combination, in comparison to left ventricular mass index assessed by echocardiography (LVMI). Design and method: 1104 hypertensive patients having at baseline an assessment of plasma NT-proBNP, a resting 12-lead ECG and an echocardiography were included. LVMI was assessable in 921 patients. After a median follow-up of 8.5 [5.4–13.3] years, 110 deaths occurred, 62 of which were from cardiovascular cause. Results: Optimal thresholds of RaVL and plasma NT-proBNP to predict mortality were 0.7 mV and 150 pg.mL-1, respectively. A 3-modality variable based on RaVL and NT-proBNP, was built: 0 when none were above the threshold, 1 or 2 when only one or both were above the threshold, respectively. After adjustment for cardiovascular risk factors, previous cardiovascular event and LVMI in Cox regression analysis, we observed a gradual increase risk for patients having 1 marker above the threshold (hazard ratio (HR) 1.76; 95% confidence interval (CI) (1.08–2.86) for all-cause mortality, HR 2.18; 95 %CI (1.06–4.46) for cardiovascular mortality) or 2 markers above the threshold (HR 2.76; 95 %CI (1.51–5.03) for all-cause mortality, HR 3.90; 95 %CI (1.69–9.00) for cardiovascular mortality); the prognostic value of the combination of RaVL and NT-proBNP was greater than that of LVMI, which did not reach statistical significance while included in the same model. Similarly, the combination demonstrated the best accuracy to predict outcome in comparison to LVMI (C-index, ROC curves and likelihood ratio test). Conclusions: Risk stratification in hypertension with the combination of NT-proBNP and RaVL is a simple method that appears more powerful and accurate than LVMI. This approach should be considered as a game changer in hypertension.