title: N-terminal pro-B-type natriuretic peptide, left ventricular mass, and incident heart failure: Multi-Ethnic Study of Atherosclerosis.
abstract: BACKGROUND
  Elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) is associated with clinically overt heart failure (HF). However, whether it provides additive prognostic information for incident HF beyond traditional risk factors and left ventricular (LV) mass index among multi-ethnic asymptomatic individuals has not yet been determined. We studied the associations of plasma NT-proBNP and magnetic resonance imaging defined LV mass index with incident HF in an asymptomatic multi-ethnic population.
  
  
  RESULTS
  A total of 5597 multi-ethnic participants without clinically apparent cardiovascular disease underwent baseline measurement of NT-proBNP and were followed for 5.5±1.1 years. Among them, 4163 also underwent baseline cardiac magnetic resonance imaging. During follow-up, 111 participants experienced incident HF. Higher NT-proBNP was significantly associated with incident HF, independent of baseline age, sex, ethnicity, systolic blood pressure, diabetes mellitus, smoking, estimated glomerular filtration rate, medications (anti-hypertensive and statin), LV mass index, and interim myocardial infarction (hazard ratio: 1.95 per 1U log NT-proBNP increment, 95% CI 1.54-2.46, P<0.001). This relationship held among different ethnic groups, non-Hispanic whites, African-Americans, and Hispanics. Most importantly, NT-proBNP provided additive prognostic value beyond both traditional risk factors and LV mass index for predicting incident HF (integrated discrimination index=0.046, P<0.001; net reclassification index; 6-year risk probability categorized by <3%, 3-10%, >10% =0.175, P=0.019; category-less net reclassification index=0.561, P<0.001).
  
  
  CONCLUSIONS
  Plasma NT-proBNP provides incremental prognostic information beyond traditional risk factors and the magnetic resonance imaging-determined LV mass index for incident symptomatic HF in an asymptomatic multi-ethnic population.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT00005487.
authors.affiliation: Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Eui-Young
authors.initials: EY
authors.lastname: Choi
authors.forename: Hossein
authors.initials: H
authors.lastname: Bahrami
authors.forename: Colin O
authors.initials: CO
authors.lastname: Wu
authors.forename: Philip
authors.initials: P
authors.lastname: Greenland
authors.forename: Mary
authors.initials: M
authors.lastname: Cushman
authors.forename: Lori B
authors.initials: LB
authors.lastname: Daniels
authors.forename: Andre L C
authors.initials: AL
authors.lastname: Almeida
authors.forename: Kihei
authors.initials: K
authors.lastname: Yoneyama
authors.forename: Anders
authors.initials: A
authors.lastname: Opdahl
authors.forename: Aditya
authors.initials: A
authors.lastname: Jain
authors.forename: Michael H
authors.initials: MH
authors.lastname: Criqui
authors.forename: David
authors.initials: D
authors.lastname: Siscovick
authors.forename: Christine
authors.initials: C
authors.lastname: Darwin
authors.forename: Alan
authors.initials: A
authors.lastname: Maisel
authors.forename: David A
authors.initials: DA
authors.lastname: Bluemke
authors.forename: Joao A C
authors.initials: JA
authors.lastname: Lima
mesh_terms: D001741:Black or African American / Q000208:ethnology; D000368:Aged; D001213:Asian / Q000208:ethnology; D015415:Biomarkers / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis* / Q000453:epidemiology* / Q000208:ethnology; D006630:Hispanic or Latino / Q000208:ethnology; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000473:pathology*; D015994:Incidence; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D044465:White People / Q000208:ethnology
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain