Celik Ahmet, Yesil Emrah, Kılıç Unal, Ozyurt Gizem Akcay, Aytimur Selman, Demir Mustafa, Eker Huseyin Naci, Col Ayse Siddika, Altiparmak Cemil Ilker, Ergen Mustafa, Bozkaya Selen, Okyay Ismail Sefa, Kerem Ibrahim Ethem, Arap Kiristin Marina, Yirtar Melike, Korkmaz Deniz, Kırdağ Ali, Ozcan Ismail Turkay
Department of Cardiology, Faculty of Medicine, Mersin University, Mersin, Turkey.
Mersin Ticaret Borsasi Primary Health Care Center, Mersin, Turkey.
ESC Heart Fail. 2025 Aug;12(4):2834-2842. doi: 10.1002/ehf2.15290. Epub 2025 Jun 2.
Early detection of heart failure (HF), particularly in asymptomatic individuals, is essential for timely intervention. This study aimed to determine the prevalence of HF among high-risk individuals in primary care using N-terminal probrain natriuretic peptide (NT-proBNP) screening.
A prospective cohort of 874 participants aged ≥40 years with at least one HF risk factor but no prior HF diagnosis was analysed. NT-proBNP levels were measured, and all participants underwent comprehensive cardiac evaluations, including laboratory tests, electrocardiography and echocardiography.
The mean age of the cohort was 62.5 ± 9.1 years, and 51.9% were female. Based on ACC/AHA HF staging, 69.1% of participants were classified as Stage A, 21.9% as Stage B and 9.0% as Stage C. Elevated NT-proBNP levels were detected in 84.8% of Stage B and 100% of Stage C patients. Among Stage C patients, 92.4% had HF with preserved ejection fraction (HFpEF). NT-proBNP levels correlated positively with left atrial volume index (r = 0.273, P < 0.001), left ventricular mass index (r = 0.207, P < 0.001), E/e' ratio (r = 0.182, P < 0.001) and estimated systolic pulmonary artery pressure (r = 0.124, P < 0.001), while showing a negative correlation with estimated glomerular filtration rate (r = -0.222, P < 0.001).
A significant proportion of high-risk individuals in primary care had undiagnosed HF, particularly Stage B (pre-HF) and early symptomatic Stage C HF. The predominance of HFpEF highlights the need for targeted management. NT-proBNP screening is a valuable tool for early identification and risk stratification, especially for detecting Stage B HF, where it serves as an effective standalone method in the absence of imaging.
心力衰竭（HF）的早期检测，尤其是在无症状个体中，对于及时干预至关重要。本研究旨在通过N端脑钠肽前体（NT-proBNP）筛查确定基层医疗中高危个体的HF患病率。
对874名年龄≥40岁、至少有一个HF危险因素但既往无HF诊断的参与者进行前瞻性队列分析。测量NT-proBNP水平，所有参与者均接受了全面的心脏评估，包括实验室检查、心电图和超声心动图检查。
该队列的平均年龄为62.5±9.1岁，女性占51.9%。根据美国心脏病学会/美国心脏协会（ACC/AHA）的HF分期，69.1%的参与者被分类为A期，21.9%为B期，9.0%为C期。84.8%的B期患者和100%的C期患者检测到NT-proBNP水平升高。在C期患者中，92.4%患有射血分数保留的心力衰竭（HFpEF）。NT-proBNP水平与左心房容积指数呈正相关（r = 0.273，P < 0.001），与左心室质量指数呈正相关（r = 0.207，P < 0.001），与E/e'比值呈正相关（r = 0.182，P < 0.001），与估计的收缩期肺动脉压呈正相关（r = 0.124，P < 0.001），而与估计的肾小球滤过率呈负相关（r = -0.222，P < 0.001）。
基层医疗中相当一部分高危个体患有未确诊的HF，尤其是B期（HF前期）和早期有症状的C期HF。HFpEF的优势突出了针对性管理的必要性。NT-proBNP筛查是早期识别和风险分层的有价值工具，特别是对于检测B期HF，在没有影像学检查的情况下，它是一种有效的独立方法。
