Role of biomarkers to identify individuals with silent cardiac disease to help improve primary prevention

摘要

ObjectivesThe aim of this study was to evaluate power of identification of silent cardiac target organ damage (TOD) in population receiving primary prevention with the use of biomarkers.BackgroundPrimary prevention of cardiovascular events could be improved by identifying patients with silent cardiac TOD (i.e., myocardial ischemia, systolic dysfunction, diastolic dysfunction, left ventricular hypertrophy or left atrial enlargement). Biomarkers used for screening included high sensitive CRP [hs-CRP] high sensitivity cardiac troponin T [hs-cTnT] , or B-type natriuretic peptide [BNP] .MethodsThe study included 271 asymptomatic individuals already receiving primary prevention therapy, they had their biomarkers evaluated. Identification of silent cardiac TOD was done by transthoracic echocardiography, stress echocardiography, and/or myocardial perfusion imaging. Carotid – femoral pulse wave velocity.ResultsShowed that ninety six (35%) patients had evidence of cTOD. Left ventricular hypertrophy evaluated by LV mass index showed the highest prevalence (32.7%), followed by left ventricular diastolic dysfunction (28.9%), left atrial enlargement (19.1%), systolic dysfunction (10.6%), ischemia (7.1%) and the lowest was PWV (2.7%). The discrimination power as evaluated by area under the curve [AUC] for BNP to identify any form of silent cTOD was 0.79 overall and 0.83 in men , while for hs-cTnT it was 0.70 and 0.74 in women. The combined AUC for BNP and hs-cTnT together was 0.81 and 0.82 in men. Week discrimination power existed for of other biomarkers, with AUCs of 0.61 for microalbuminuria, 0.60 for hs-CRP , and 0.58 for eGFR.ConclusionsAsymptomatic patients treated for primary prevention, existing silent cTOD could be identified by BNP screening. The result of hs-cTnT was weaker than that of BNP. Combining BNP plus hs-cTnT together showed best results. Primary prevention could be improved by Prescreening with BNP±cTnT followed by phenotyping.