Key result
Having both RaVL >0.7 mV and NT-proBNP >150 pg/ml increased the risk of all-cause mortality compared to having neither marker elevated.
Why the study?
Plasma NT-proBNP and RaVL predict mortality in hypertension, but whether their combination compares favorably to echocardiographic LVMI remained uncharacterized.
Does the combination of NT-proBNP and RaVL improve prognostic risk stratification for mortality compared to LVMI in hypertensive patients?
Cohort (n=1,104)
Does the combination of NT-proBNP and RaVL improve prognostic risk stratification for mortality compared to LVMI in hypertensive patients?
The combination of NT-proBNP and RaVL provides a simple and superior prognostic tool for mortality risk stratification in hypertensive patients compared to echocardiographic LVMI.
Answers are grounded in this paper and cite their sources.
Should not yet change practice; hypothesis-generating for combined ECG-biomarker risk stratification in hypertension.
OBJECTIVES: Plasma N-terminal pro brain natriuretic peptide (NT-proBNP) and R wave in aVL lead (RaVL) have been associated with mortality in hypertension. The aim of the current study was to compare the prognostic value of their combination to that of the left ventricular mass index (LVMI) assessed by echocardiography. METHODS: A total of 1104 hypertensive patients who had at baseline an assessment of plasma NT-proBNP, a 12-lead ECG, and echocardiography were included. LVMI was assessable in 921 patients. After a median (interquartile range) follow-up of 8.5 (5.4-13.3) years, 110 deaths occurred, 62 of which were from a cardiovascular cause. RESULTS: Optimal thresholds of RaVL and plasma NT-proBNP to predict mortality were 0.7 mV and 150 pg/ml, respectively. A three-modality variable based on RaVL and NT-proBNP was built: 0 when none were above the threshold, 1 or 2 when only one or both were above the threshold. After adjustment for all confounders including LVMI indexed to height raised to the allometric power of 2.7 in Cox regression analysis, we observed a significant increased risk for patients having one marker above the threshold for all-cause and cardiovascular mortality [hazard ratio: 1.76; 95% confidence interval (1.08-2.86); 2.18 (1.06-4.46)] and for those having two markers above the threshold [2.76 (1.51-5.03); 3.90 (1.69-9.00)]. The prognostic value of the combination had the highest C-index (0.772 and 0.839, respectively) in comparison with LVMI (0.746 and 0.806, respectively). CONCLUSION: Risk stratification in hypertension using the combination of NT-proBNP and RaVL is a simple method that may be considered in first line screening.
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Grandjean et al. (2019) conducted a cohort in Hypertension (n=1,104). Elevated RaVL (>0.7 mV) and NT-proBNP (>150 pg/ml) vs. Neither marker elevated was evaluated on All-cause mortality (HR 2.76, 95% CI 1.51-5.03). Having both RaVL >0.7 mV and NT-proBNP >150 pg/ml increased the risk of all-cause mortality compared to having neither marker elevated.
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