A multimodality testing score of abnormal tests significantly improved global CVD risk assessment, with a score of ≥4 associated with a 7.5-fold increased risk (95% CI, 5.2-10.6) compared to 0.
Cohort (n=8,823)
Yes
Does a multimodality testing strategy combining ECG, imaging, and biomarkers improve global and atherosclerotic cardiovascular disease risk assessment in adults without known cardiovascular disease?
A multimodality testing strategy combining ECG, coronary artery calcium, and biomarkers significantly improves the prediction of global CVD and ASCVD risk in adults without known cardiovascular disease.
Effect estimate: HR 7.5 (95% CI 5.2-10.6)
BACKGROUND: Current strategies for cardiovascular disease (CVD) risk assessment among adults without known CVD are limited by suboptimal performance and a narrow focus on only atherosclerotic CVD (ASCVD). We hypothesized that a strategy combining promising biomarkers across multiple different testing modalities would improve global and atherosclerotic CVD risk assessment among individuals without known CVD. METHODS: We included participants from MESA (Multi-Ethnic Study of Atherosclerosis) (n=6621) and the Dallas Heart Study (n=2202) who were free from CVD and underwent measurement of left ventricular hypertrophy by ECG, coronary artery calcium, N-terminal pro B-type natriuretic peptide, high-sensitivity cardiac troponin T, and high-sensitivity C-reactive protein. Associations of test results with the global composite CVD outcome (CVD death, myocardial infarction, stroke, coronary or peripheral revascularization, incident heart failure, or atrial fibrillation) and ASCVD (fatal or nonfatal myocardial infarction or stroke) were assessed over >10 years of follow-up. Multivariable analyses for the primary global CVD end point adjusted for traditional risk factors plus statin use and creatinine (base model). RESULTS: =0.20). Using a simple integer score counting the number of abnormal tests, compared with those with a score of 0, global CVD risk was increased among participants with a score of 1 (adjusted hazard ratio, 1.9; 95% CI, 1.4-2.6), 2 (hazard ratio, 3.2; 95% CI, 2.3-4.4), 3 (hazard ratio, 4.7; 95% CI, 3.4-6.5), and ≥4 (hazard ratio, 7.5; 95% CI, 5.2-10.6). Findings replicated in the Dallas Health Study were similar for the ASCVD outcome. CONCLUSIONS: Among adults without known CVD, a novel multimodality testing strategy using left ventricular hypertrophy by ECG, coronary artery calcium, N-terminal pro B-type natriuretic peptide, high-sensitivity cardiac troponin T, and high-sensitivity C-reactive protein significantly improved global CVD and ASCVD risk assessment.
Lemos et al. (Fri,) conducted a cohort in Adults without known cardiovascular disease (n=8,823). Multimodality testing strategy (integer score of abnormal tests) vs. Score of 0 (no abnormal tests) was evaluated on Global composite CVD outcome (CVD death, myocardial infarction, stroke, coronary or peripheral revascularization, incident heart failure, or atrial fibrillation) (HR 7.5, 95% CI 5.2-10.6). A multimodality testing score of abnormal tests significantly improved global CVD risk assessment, with a score of ≥4 associated with a 7.5-fold increased risk (95% CI, 5.2-10.6) compared to 0.