Association of novel biomarkers of cardiovascular stress with left ventricular hypertrophy and dysfunction: implications for screening.

Currently available screening tools for left ventricular (lv) hypertrophy (lvh) and systolic dysfunction (lvsd) are either expensive (echocardiography) or perform suboptimally (b-type natriuretic peptide [bnp]). it is unknown whether newer biomarkers are associated with lvh and lvsd and can serve as screening tools. we studied 2460 framingham study participants (mean age 58 years,57% women) with measurements of biomarkers mirroring cardiac biomechanical stress (soluble st-2 [st2],growth differentiation factor-15 [gdf-15] and high-sensitivity troponin i [hstni]) and bnp. we defined lvh as lv mass/height(2) ≥the sex-specific 80th percentile and lvsd as mild/greater impairment of lv ejection fraction (lvef) or a fractional shortening <0.29. adjusting for standard risk factors in logistic models,bnp,gdf-15,and hstni were associated with the composite echocardiographic outcome (lvh or lvsd),odds ratios (or) per sd increment in log-biomarker 1.29,1.14,and 1.18 (95% ci: 1.15 to 1.44,1.004 to 1.28,and 1.06 to 1.31),respectively. the c-statistic for the composite outcome increased from 0.765 with risk factors to 0.770 adding bnp,to 0.774 adding novel biomarkers. the continuous net reclassification improvement was 0.212 (95% ci: 0.119 to 0.305,p<0.0001) after adding the novel biomarkers to risk factors plus bnp. bnp was associated with lvh and lvsd in multivariable models,whereas gdf-15 was associated with lvsd (or 1.41,95% ci: 1.16 to 1.70),and hstni with lvh (or 1.22,95% ci: 1.09 to 1.36). st2 was not significantly associated with any outcome. our community-based investigation suggests that cardiac stress biomarkers are associated with lvh and lvsd but may have limited clinical utility as screening tools.