Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
Inserm U1300 -HP2, Université Grenoble Alpes, CHU Grenoble Alpes, Grenoble, France.
PLoS One. 2022 Jul 25;17(7):e0271835. doi: 10.1371/journal.pone.0271835. eCollection 2022.
Echocardiographic measures are known predictors of cardiovascular disease (CVD) in the general population. This study compared the predictive value of such measures to that of circulating cardiac biomarkers for a composite cardiovascular disease outcome in an aging population.
In this prospective population-based cohort study, echocardiography was performed at baseline together with assessments of traditional CVD risk factors and circulating cardiac biomarkers, NT-proBNP and troponin I, in 1016 individuals all aged 70 years. Assessments were repeated at ages 75 and 80. A composite CVD outcome (myocardial infarction, heart failure or ischemic stroke) was charted over 15 years. All echocardiography variables, except for the E/A ratio, were analyzed on a continuous scale.
Over 10 years, left atrial (LA) diameter, left ventricular mass index (LVMI) and high E/A ratio (>1.5) increased, while left ventricular ejection fraction (LVEF) remained unchanged. Using Cox proportional hazard analyses with time-updated variables for echocardiographic measures and traditional risk factors, an enlarged LA diameter and a low LVEF were independently related to incident CVD in 222 participants. The addition of LA diameter and LVEF to traditional risk factors increased the C-statistic by 1.5% (p = 0.008). However, the addition of troponin I and NT-proBNP to traditional risk factors increased the C-statistic by 3.0% (p<0.001).
An enlarged LA diameter and a low LVEF improved the prediction of incident CVD compared to traditional risk factors. However, given that troponin I and NT-proBNP improved prediction to a similar extent, the use of simple blood tests to improve clinical cardiovascular disease risk prediction is only further supported by this study.
超声心动图测量值是一般人群心血管疾病（CVD）的已知预测因子。本研究比较了这些测量值与循环心脏生物标志物对老龄化人群复合心血管疾病结局的预测价值。
在这项前瞻性的基于人群的队列研究中，对 1016 名年龄均为 70 岁的个体进行了基线超声心动图检查，并评估了传统 CVD 风险因素和循环心脏生物标志物，即 NT-proBNP 和肌钙蛋白 I。在 75 岁和 80 岁时进行了重复评估。在 15 年内记录复合 CVD 结局（心肌梗死、心力衰竭或缺血性中风）。除 E/A 比值外，所有超声心动图变量均在连续尺度上进行分析。
在 10 年内，左心房（LA）直径、左心室质量指数（LVMI）和高 E/A 比值（>1.5）增加，而左心室射血分数（LVEF）保持不变。使用 Cox 比例风险分析，对超声心动图测量值和传统危险因素进行时间更新变量分析，在 222 名参与者中，增大的 LA 直径和低 LVEF 与 CVD 事件独立相关。将 LA 直径和 LVEF 添加到传统危险因素中，C 统计量增加了 1.5%（p=0.008）。然而，将肌钙蛋白 I 和 NT-proBNP 添加到传统危险因素中，C 统计量增加了 3.0%（p<0.001）。
与传统危险因素相比，增大的 LA 直径和低 LVEF 改善了 CVD 事件的预测。然而，鉴于肌钙蛋白 I 和 NT-proBNP 也改善了预测程度，因此本研究仅进一步支持使用简单的血液测试来改善临床心血管疾病风险预测。
