Biomarkers of cardiovascular stress and left ventricular hypertrophic patterns: cross-sectional relations and prognostic significance

Background: Cardiac stress biomarkers (growth differentiation factor 15 [GDF-15], soluble ST-2 [ST2], high-sensitivity troponin I [hsTnI]) and B-type natriuretic peptide [BNP]) are associated with incident heart failure (HF) and left ventricular mass (LVM). It is unclear if biomarker levels and their prognostic significance vary according to LV hypertrophy (LVH) pattern and extent. We hypothesized that concentric & eccentric LVH would be associated with highest biomarker levels; presence of both LVH and higher biomarker levels would indicate high HF risk. Methods and Results: We evaluated 2,425 Framingham Study participants free of HF (57% women, mean age 58 years) attending a routine examination, with available biomarker and echocardiographic measurements. We defined 4 LVH patterns: a. normal (normal LVM and Relative Wall Thickness [RWT]); b. concentric remodeling (normal LVM, elevated RWT); c. eccentric hypertrophy (elevated LVM, normal RWT); and d. concentric hypertrophy (elevated LVM and RWT). Adjusting for age & sex, biomarker levels (except BNP) increased sequentially across LVH patterns a-d ( Figure ). BNP levels were lowest in concentric remodeling and highest in eccentric LVH. In multivariable models, all biomarkers were associated with incident HF (106 cases, 12 yrs follow-up). We observed a significant interaction only between BNP and LVM (p=0.02). In stratified analyses, higher LVM was associated with incident HF in both BNP strata (Hazard Ratios [HR] per SD increase in LVM = 2.24 [更多