USA: Cardiac Biomarkers in Heart Failure Assessment

A recent study has suggested that cardiac biomarkers incorporation into HF (heart failure) assessment may better pinpoint patients otherwise missed by older disease definitions. Researchers have found in the ARIC study that inclusion of cardiac biomarkers into HF assessment may better pinpoint patients who otherwise would have been missed by older disease definitions. One in five asymptomatic elderly individuals in the study were reclassified from Stage A to Stage B through the inclusion of natriuretic peptide or cardiac troponin elevations.

"The routine biomarkers measurement can help identify people at higher risk of heart failure who may benefit most from HF prevention efforts."

The study has been published online in JACC: Heart Failure.

The findings align with recommendations from the most recent heart failure guidelines from the ACC (American College of Cardiology), the AHA (American Heart Association), and the HFSA (Heart Failure Society of America). The guidelines revised the HF staging system, emphasizing early detection of stage A (at risk) and stage B or pre-HF (asymptomatic with structural evidence of heart dysfunction). The guidelines recommend blood tests for cardiac troponin and natriuretic peptides in Stage B assessment in keeping with a proposed new universal HF definition.

Xiaoming Jia from Baylor College of Medicine in Houston, Texas, USA, and colleagues evaluated the impact of cardiac biomarkers incorporation to reclassify heart failure in 5,324 participants (mean age, 75.8 years) without prevalent HF enrolled in the Atherosclerosis Risk in Communities study and assessed Stage B prognosis using cardiac biomarkers.

Individuals were classified as Stage A_new and Stage B_new HF using N-terminal pro–B-type natriuretic peptide (<125 pg/mL or ≥125 pg/mL), abnormal cardiac structure/function by echocardiography, and high-sensitivity troponin T (<14 ng/L or ≥14 ng/L). Further evaluation of Stage B_new was done as elevated biomarker only, abnormalities in both (echo + biomarker), and abnormal echocardiogram only. Risk for incident HF and all-cause death was also assessed.

Findings

• 81.3% of individuals were classified as Stage B_new, with 21.1% meeting the criteria for elevated biomarkers only.
• Compared with Stage A_new, Stage B_new was associated with an increased risk of incident HF (HR: 3.70) and death (HR: 1.94).
• Stage B_{biomarkers only} and Stage B_{echo only} were associated with increased HF risk, whereas Stage B_{biomarkers only} were also associated with increased death.
• Stage B_{echo+biomarker} had the highest risk for HF (HR: 6.34) and death (HR: 2.53).

"Incorporation of cardiac biomarkers based on the new HF guideline, approximately one in five older adults without prevalent heart failure to Stage B," the researchers wrote. "The routine biomarkers' measurement can help in identifying individuals at higher HF risk who may benefit from efforts of HF prevention."

Reference

Jia, X., Al Rifai, M., Ndumele, C. E., Virani, S. S., de Lemos, J. A., Lee, E., Shah, A. M., Echouffo-Tcheugui, J. B., Bozkurt, B., Hoogeveen, R., Selvin, E., Ballantyne, C. M., & Nambi, V. (2023). Reclassification of Pre-Heart Failure Stages Using Cardiac Biomarkers: Atherosclerosis Risk in Communities (ARIC) Study. JACC: Heart Failure. https://doi.org/10.1016/j.jchf.2022.12.005