Imaging and Cardiac Biomarker Associations With Preclinical Heart Failure Stage B to C Progression

linical practice guidelines define preclinical heart failure (HF) or “stage B” as those individuals with evidence of structural or functional cardiac abnormalities by imaging but without clinical signs and symptoms of HF (ie, stage C or D). 1 Recently, elevated circulating cardiac biomarkers of myocardial injury and elevated venous pressure, specifically cardiac troponin and brain natriuretic peptide, both potent predictors of incident HF in otherwise asymptomatic individuals have been included as markers of stage B HF. 1 Prior work has shown that imaging abnormalities such as asymptomatic left ventricular (LV) dysfunction, abnormal global longitudinal strain, diastolic dysfunction, and valvular heart disease predict progression to stage C; however, these analyses were performed in separate studies precluding direct comparison with each other 2 or did not examine the relative strength of association. 3 There is a paucity of comparative analysis on the degree to which different markers of stage B impact HF stage progression. We therefore sought to determine the degree to which abnormalities of cardiac structure and function based on echocardiography or elevated cardiac biomarkers predicted the progression from stage B to stage C HF.