{
  "abstract": "Background While natriuretic peptides (NPs) are central to heart failure (HF) risk stratification, particularly in symptomatic populations, the incremental prognostic value of structural and diastolic echocardiographic markers alongside NP levels in preclinical HF remains less clearly defined.Objective To assess whether echocardiographic parameters predict clinical outcomes independently of, and synergistically with, BNP in a preclinical HF cohort.Methods We retrospectively analysed 1,425 participants from the STOP-HF programme. All patients underwent baseline BNP assessment and comprehensive Doppler echocardiography. Outcomes included acute decompensated HF events (ADHFE), non-HF cardiovascular events (NHFCE), non-cardiac events (NCE), and a composite of all events over a mean 5.4 years. Multivariate and stepwise logistic regression models adjusted for age, sex, and BNP were used to evaluate independent predictors.Results In multivariate models adjusted for age, sex, and BNP, several echocardiographic parameters remained independently associated with clinical outcomes. For ADHFE, LVIDd (p<0.001), LAVI (p=0.0032), and E/e′ (p=0.0231) remained significant alongside BNP (p=0.004). For NHFCE, LAVI (p=0.0064) and E/e′ (p=0.0062) were predictive, while BNP was not (p=0.76), suggesting diastolic burden rather than neurohormonal activation as a key driver. No variables predicted NCE. For the composite outcome, LAVI (p=0.0253), E/e′ (p=0.0056), and BNP (p=0.0044) were independently associated with risk. Stepwise regression confirmed these findings, selecting age, BNP, LVIDd, LAVI, and E/e′ as the strongest predictors, while excluding LVMI. This highlights that direct measures of chamber size and filling pressure were more prognostically informative than mass indices in preclinical HF.Conclusion Structural and functional echocardiographic markers provide significant, independent prognostic information beyond BNP, particularly for acute HF and composite outcomes. These findings support a multimodal risk stratification strategy in preclinical HF, combining biomarkers with imaging to improve early detection of adverse trajectories.",
  "authors": [
    {
      "affiliations": [
        "St Vincents University Hospital, Dublin, Ireland"
      ],
      "name": "A Moore"
    },
    {
      "affiliations": [
        "St Vincents University Hospital, Dublin, Ireland"
      ],
      "name": "M Barrett"
    },
    {
      "affiliations": [
        "St Vincents University Hospital, Dublin, Ireland"
      ],
      "name": "J Gallagher"
    },
    {
      "affiliations": [
        "St Vincents University Hospital, Dublin, Ireland"
      ],
      "name": "M Ledwidge"
    },
    {
      "affiliations": [
        "St Vincents University Hospital, Dublin, Ireland"
      ],
      "name": "K McDonald"
    }
  ],
  "title": "39 Beyond biomarkers: echocardiographic predictors of clinical events in preclinical heart failure",
  "uid": "2238bc71-6d68-5bd4-b525-9425def28fd8"
}