“Malignant” LV Hypertrophy, Cardiac Biomarkers, and HFrEF | Journal Scan

Study Questions:

Can biomarkers of myocardial injury distinguish heart failure (HF) risk among older adults with left ventricular hypertrophy (LVH)?

Methods:

Participants enrolled in the CHS (Cardiovascular Health Study) who did not have HF were included. N-terminal pro–B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) were measured in serum samples at baseline and at 2-3 years. LVH was measured using echocardiography, and the primary outcome, incident HF, was determined by interview, examination of medical records, and Medicare claims data. NT-proBNP and hs-cTnT were analyzed by tertiles and by longitudinal change in levels. Survival analyses were performed for incident HF and separately for HF with preserved ejection fraction (HFpEF) and HF with reduced EF (HFrEF).

Results:

Of the 2,347 participants, 294 had LVH. LVH was most prevalent in the highest tertiles of NT-proBNP and hs-cTnT, 18.1% and 19.3%, respectively. Hypertension was more prevalent among those with LVH compared to those without, 74% vs. 55%, respectively. The risk of incident HF varied by the presence of LVH and tertile of biomarker. Patients with LVH who were in the highest NT-proBNP tertile had >4-fold increased risk of HF compared to those without LVH and in the lowest tertile of NT-proBNP (hazard ratio [HR], 4.42; 95% confidence interval [CI], 3.28-5.94). Similarly, those with LVH and in the highest tertile of hs-cTnT had an almost 6-fold increased risk of incident HF (HR, 5.88; 95% CI, 4.37-7.90). The risk of incident HF among those with LVH and higher levels of biomarkers was moderately attenuated, but remained increased after adjustment for confounders. The risk of both incident HFrEF and HFpEF also varied by presence of LVH and tertile of biomarker, with the highest risk of HFrEF and HFpEF among those with LVH and in the highest biomarker tertile. Compared to those with stable NT-proBNP or hs-cTnT, those with LVH and increasing levels had a 3-fold increase in risk of incident HF. Increasing NT-proBNP and hs-cTnT was associated with increased risk of HFrEF, but not HFpEF.

Conclusions:

The presence of LVH combined with elevated or increasing levels of NT-proBNP or hs-cTnT identifies older adults at risk for developing HF. These biomarkers may characterize a group of patients with LVH who may benefit from targeted interventions to prevent progression from LVH to HF.

Perspective:

This study provides evidence that biomarkers of myocardial injury and strain can further differentiate risk among older patients with LVH, providing a potential phenotype as a target for prevention of HF, particularly HFrEF. The finding that increases in biomarkers were associated with increased risk of HFrEF and not HFpEF among patients with LVH highlights the fact that LVH is a heterogeneous process. Further study is needed to evaluate the benefit of interventions guided by these phenotypes.

Clinical Topics: Anticoagulation Management, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Prevention, Acute Heart Failure, Heart Failure and Cardiac Biomarkers, Echocardiography/Ultrasound, Hypertension

Keywords: Aged, Biological Markers, Echocardiography, Geriatrics, Heart Failure, Hypertension, Hypertrophy, Left Ventricular, Medical Records, Medicare, Natriuretic Peptide, Brain, Peptide Fragments, Phenotype, Prevalence, Secondary Prevention, Stroke Volume, Survival Analysis, Troponin T


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