Background: The recent heart failure clinical guidelines have put forward a new recommendation for patients at risk of developing heart failure that natriuretic peptide biomarker-based screening followed by team-based care can be useful to prevent left ventricular dysfunction or new-onset heart failure. Data on the prevalence and prognostic value of elevated NT-proBNP levels by routine testing in at-risk patients seen in the clinical practice setting are lacking.
Hypothesis: We hypothesize that elevated NT-proBNP levels are prevalent and portent increased mortality risk in this at-risk population.
Methods: We measured NT-proBNP levels (Roche) in 5,845 sequential stable consenting subjects without acute coronary syndrome who underwent elective cardiac angiography between 2001-6 for symptom evaluation without a clinical diagnosis of heart failure at the time of enrollment and no significant renal dysfunction (eGFR >60 ml/min/1,73m2). All-cause mortality was determined by prospective follow-up by direct contact, electronic medical record review, and social security death index review up to 5 years.
Results: In our study cohort (mean age 62±11 years, 71% male, 32% diabetes, 68% hypertension, 67% with prior coronary artery disease, median eGFR 88.6 ml/min/1.73m2), median NT-proBNP level was 165 (interquartile range 68-416) pg/mL. Elevated NT-proBNP levels were associated with increased risk of 5-year mortality (cutoff at 165 pg/mL: HR 2.54, 95%CI 1.84-3.51, p<0.001; cut-off at 416 pg/mL: HR 4.78, 95%CI 3.53-6.47, p<0.001). After adjusting for traditional cardiac risk factors, the prognostic value of elevated NT-proBNP for mortality risk remained statistically significant (cutoff at 165 pg/mL: HR 1.62, 95%CI 1.15-2.30, p<0.01; cut-off at 416 pg/mL: HR 2.80, 95%CI 2.02-3.89, p<0.001).
Conclusion: In the absence of a clinical diagnosis of heart failure and no underlying renal insufficiency, elevated NT-proBNP levels are prevalent and portend increased mortality risk in stable patients undergoing elective coronary angiography for cardiac evaluation who are at risk of developing heart failure.