Amir Ali Rahsepar1, Mohammadali Habibi2, Cheeling Chan3, Nadine kawel2, Kiang Liu3, Joao Lima2, and James Carr1
1Radiology, Northwestern University, Chicago, IL, United States, 2Cardiology, Johns Hopkins University, Baltimore, MD, United States, 3Preventive medicine, Northwestern University, Chicago, IL, United States
Synopsis
In this large cross-sectional study, we found that higher levels of Pro-B-Type Natriuretic Peptide is associated with regional left
ventricular function and dyssynchrony measured by MRI in asymptomatic patients participated in The Multi-Ethnic Study
of Atherosclerosis (MESA) study.Introduction
Pro-B-Type Natriuretic Peptide (BNP) is a
regulator of cardiovascular function, and is elevated in acute myocardial
infarction (MI) and heart failure [1]. Cardiac magnetic resonance imaging (MRI) can
determine peak systolic circumferential strain (Ecc) as a measure of
regional systolic function and difference in time to peak systolic circumferential
strain (TPS) as a measure of regional myocardial dysfunction [2]. We aimed to
examine the association between BNP levels with Ecc and TPS among asymptomatic participants
of the Multi-Ethnic Study of Atherosclerosis (MESA).
Methods
A total of 868 participants (mean age 66, 44%
women) with Pro-BNP measures and Ecc calculated from tagged MRI were included. Ecc
and TPS was analyzed by harmonic phase imaging separately in mid LV anterior
wall, septum, lateral wall, and inferior wall. Global Ecc was calculated as the
average of Ecc in all myocardial segments. Linear regression models were used to investigate
the association of BNP levels with Ecc and LV dyssynchrony, adjusting for
traditional risk factors (TRF): age, sex, race, education, physical activity,
cigarette smoking, diabetes, BMI, systolic blood pressure, anti-hypertensive
medication use, HDL cholesterol, total cholesterol, statin use, and prevalence
of CAC>10.
Results
The median BNP
level (interquartile range) was 64.0 (28.6 – 130.4) pg/mL. Individuals with
elevated levels of BNP were more likely to be older, have higher blood pressure
and higher prevalence of Coronary Artery Calcium (CAC)>10. In multivariable models
adjusted for TRF, there was significant reduction of global Ecc (P=0.030) and systolic function in the
anterior wall (P=0.007) with 1 SD
increases in log-transformed BNP (Table 1), and higher BNP levels
were associated with greater TPS for all regions of analysis (Table 2).
Conclusion
Among asymptomatic
individuals without documented cardiovascular disease, elevated BNP levels were
associated with reduced regional LV systolic function and greater extent of
myocardial dysfunction. These associations implicate BNP is a strong and
independent prognostic marker in the pathogenesis of cardiovascular disease and
heart failure. However, the observed associations and findings warrant further
investigation.
Acknowledgements
MESA Family is conducted and supported by the National Heart, Lung, and Blood Institute (NHLBI) in
collaboration with MESA investigators. Support is provided by grants and contracts R01HL071051,
R01HL071205, R01HL071250, R01HL071251, R01HL071258, R01HL071259, UL1-RR-025005, by the National
Center for Research Resources, Grant UL1RR033176, and the National Center for Advancing Translational
Sciences, Grant UL1TR000124.References
[1] Don-Wauchope AC et al. Evidence based application of BNP/NT-proBNP testing in heart failure. Clin Biochem. 2015.
[2] Garot J et al. Fast determination of regional myocardial strain fields fromtagged cardiac images using harmonic phase MRI. Circulation 2000.