Screening for asymptomatic heart failure with preserved ejection fraction in mongolian population at high risk

Objective The goals of the present study were to assess the prevalence of asymptomatic heart failure with preserved ejection fraction (HFpEF) in subjects at high risk of developing HF and to define the diagnostic accuracy of NT-pro BNP assay compared with echocardiography in this setting.
Material and methods This cross-sectional study included subjects aged from 35 to 64 years, with high risk of HF, who had no clinical symptoms of HF. Risk factors of HF were detected by clinical examinations. NT-pro BNP determination was performed using immunoassay analyzer (FIA8000, Getein Bio Medical Inc, China),. The cut-off point for NT-pro BNP was 125 pg/ml. Diagnosis of HFpEF was based on criteria recommended by 2016 ESC heart failure guidelines. Diastolic dysfunction was assessed according to the algorithm proposed in the joint recommendations of the ASE/EACVI.
Results 602 patients with risk factors of HF were included in the study, of which 256 (42.5 %) were males and 346 (57.5 %) females. The mean age was 51.71±8.07 years. 83 patients (13.8 %) showed elevated NT-pro BNP levels of ≥125 pg / ml. Our study has shown that NT-pro BNP concentration was positively correlating with age, both systolic and diastolic blood pressure, left ventricular mass and E / e’ ratio and negatively correlating with waist circumference, body mass index, left ventricular EF and E / A ratio in asymptomatic population. The likelihood of positive NT-pro BNP test was independently (p<0.05) associated with age, hypertension and diabetes. The diagnosis of asymptomatic HFpEF was confirmed in 12.3 % of studied population. A cutoff value of 125 pg / ml for NT-proBNP concentration showed the following diagnostic re-abilities in identifying asymptomatic HFpEF: sensitivity 85.0 %, specificity 88.6 % and area under curve 0.92 (95 % CI 0.86–0.98).
Conclusion Subjects with raised NT-pro BNP level (≥125 pg/ml) were more likely to have a confirmed diagnosis of asymptomatic HFpEF after screening. In summary, in at-risk population, natriuretic peptide based screening combined with echocardiography identifies high prevalence of asymptomatic HFpEF.

1. World Health Organization. World Health Statistics 2017: Monitoring health for the SDGs. 2017. [Internet] 2017. Available at: http://www.who.int/gho/publications/world_health_statistics/2017/en

2. Ledwidge M, Gallagher J, Conlon C, Tallon E, O’Connell E, Dawkins I et al. Natriuretic Peptide-Based Screening and Collaborative Care for Heart Failure: The STOP-HF Randomized Trial. JAMA. 2013;310(1):66-74. https://doi.org/10.1001/jama.2013.7588

3. Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB et al. Heart Disease and Stroke Statistics-2012 Update: A Report from the American Heart Association. Circulation. 2012;125(1):e2-220. https://doi.org/10.1161/CIR.0b013e31823ac046

4. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. European Heart Journal. 2016;37(27):2129-200. https://doi.org/10.1093/eurheartj/ehw128

5. Ahmad T, O’Connor CM. Therapeutic Implications of Biomarkers in Chronic Heart Failure. Clinical Pharmacology & Therapeutics. 2013;94(4):468-79. https://doi.org/10.1038/clpt.2013.139

6. Belenkov Yu.N., Mareev V.Yu., Ageev F.T., Fomin I.V., Badin Yu.V., Polyakov D.S. et al. Veritable prevalence of CHF in the European part of Russian Federation (EPOCHA trial, hospital stage). Russian Heart Failure Journal. 2011;12(2):63-8

7. Shalnova S.A., Imaeva A.E., Deev A.D., Metelskaya V.A., Muromtseva G.A., Konradi A.O. et al. Elevated Level of the Natriuretic Peptide Among Adult Population in Regions Participating in the ESSE-RF Study and Its Association with Cardiovascular Diseases and Risk Factors. Kardiologiia. 2017;57(12):43-52. PMID: 29466210

8. Tanaka A, Yoshida H, Kawaguchi A, Oyama J, Kotooka N, Toyoda S et al. N-terminal pro-brain natriuretic peptide and associated factors in the general working population: a baseline survey of the Uranosaki cohort study. Scientific Reports. 2017;7(1):5810. https://doi.org/10.1038/s41598-017-06090-6

9. Betti I, Castelli G, Barchielli A, Beligni C, Boscherini V, De Luca L et al. The Role of N-terminal PRO-Brain Natriuretic Peptide and Echocardiography for Screening Asymptomatic Left Ventricular Dysfunction in a Population at High Risk for Heart Failure. The PROBE-HF Study. Journal of Cardiac Failure. 2009;15(5):377-84. https://doi.org/10.1016/j.cardfail.2008.12.002

10. Taylor CJ, Roalfe AK, Iles R, Hobbs FDR. The potential role of NT-proBNP in screening for and predicting prognosis in heart failure: a survival analysis. BMJ Open. 2014;4(4):e004675. https://doi.org/10.1136/bmjopen-2013-004675

11. Verdú JM, Comín-Colet J, Domingo M, Lupón J, Gómez M, Molina L et al. Rapid Point-of-Care NT-proBNP Optimal Cut-off Point for Heart Failure Diagnosis in Primary Care. Revista Española de Cardiología (English Edition). 2012;65(7):613-9. https://doi.org/10.1016/j.rec.2012.01.021