Clinical Risk Stratification Optimizes Value of Biomarkers to Predict New Onset Heart Failure in a Community-Based Cohort
Background—We aim to identify and quantify the value of biomarkers for incident new onset heart failure (HF) in a community-based cohort and subgroups based on cardiovascular risk, and evaluate the prognostic value of 13 biomarkers for HF with reduced (HFrEF) and preserved ejection fraction (HFpEF).
Methods and Results—13 biomarkers reflecting diverse pathophysiologic domains were examined in 8569 heart failure-free participants in PREVEND; mean age: 49 years, 50% male). Subjects were categorized in two risk groups based on cardiovascular history. Incremental value per biomarker was assessed using Harrell's C-indices. 168 subjects (2.4%) were diagnosed with new onset HF in the low risk group (N=6915; Framingham Risk Score (FRS): 5.9%) and 206 (12.2%) subjects in the high risk group (N=1654; FRS: 18.6%). The association of natriuretic peptides, adrenomedullin, endothelin and galectin-3 with new onset HF was stronger in the high risk group (all P<0.05). Troponin-T, highly-sensitive C-reactive protein, urinary albumin excretion and cystatin-C had similar risk for new onset HF between both risk groups. The best model for new onset HF included the combination of NT-proBNP, troponin-T and UAE, increasing model accuracy to 0.81 (9.5%, P<0.001) in the high risk group. Except for a modest effect of cystatin-C, no biomarker was associated with increased risk for HFpEF.
Conclusions—Risk stratification increases the incremental value per biomarker to predict new onset HF, especially HFrEF. We suggest that routine biomarker testing should be limited to the use of natriuretic peptides and troponin-T in patients with increased cardiovascular risk.
- Received February 6, 2014.
- Accepted July 17, 2014.