Addition of Highly Sensitive Troponin T and N-Terminal Pro-BNP to Electrocardiography for Detection of Left Ventricular Hypertrophy: Results from the Dallas Heart Study

摘要

Left ventricular hypertrophy (LVH) is an independent, modifiable risk factor for cardiovascular disease. However, current screening strategies are limited. In 2478 participants without clinical disease from the Dallas Heart Study, we evaluated a multi-marker screening strategy that complements electrocardiographic (ECG) criteria for LVH with two biomarkers, amino-terminal pro-B-type natriuretic peptide (NT-proBNP) and highly sensitive cardiac troponin T (cTnT). An integer LVH risk score from 0 to 3 was determined as the sum of: (1) LVH by Sokolow-Lyon ECG, (2) NT-proBNP in the highest sex-specific quartile, and (3) detectable cTnT. Cardiac MRI-determined LVH served as the primary outcome.The probability of LVH increased from 2% with an LVH risk score of 0 to 50% with a score of 3 (p < 0.001). S-L ECG afforded low sensitivity (26%, 95% CI 17–32%) and high specificity (96%, 95% CI 95–97%), while a risk score ≥2 offered higher sensitivity (44%, 95% CI 34–51%) with good specificity (90%, 95% CI 89–93%), a score threshold of 1 offered reasonable sensitivity (76%, 95% CI 67–83%) with lower specificity (55%, 95% CI 53–61%) and high negative predictive value (98%, 95% CI 97–98%). AUC improved from 0.760 (95% CI 0.716–0.804) for ECG alone to 0.798 (95% CI 0.754–0.842) for the LVH risk score (p = 0.0012) consistent with modest improvement in overall discrimination. Better screening for LVH may be achieved by combining simple tests, which collectively provide additional information compared to ECG alone. Further studies are needed to evaluate the impact and cost-effectiveness of a multi-marker screening strategy.