Modest NT-proBNP Elevation in Septuagenarians Without Heart Failure Is Not Associated with Cardiac Alterations or Cardiovascular Outcomes

<b>Background/Objectives:</b> To assess the association between moderate N-terminal natriuretic peptide (NT-proBNP) and cardiac alterations and prognosis in septuagenarians without heart failure (HF). <b>Methods:</b> From the STROKESTOP II screening study, 230 individuals aged 75/76 years with NT-proBNP < 900 ng/L were randomly selected. Subjects with persistent atrial fibrillation (AF), more than mild valvular disease, or HF were excluded. Echocardiography was performed. NT-proBNP ≥ 125 ng/L and paroxysmal AF (pAF) on thumb ECG were used as grouping variables. Participants were followed up during a median of 5 years for cardiovascular mortality, HF, AF, and cerebrovascular events. Cox regression analysis was employed for prognostic assessment. <b>Results:</b> Three groups were identified: SR ≥ 125 (<i>n</i> = 94, no pAF and NT-proBNP ≥ 125 ng/L), pAF (<i>n</i> = 77, pAF and NT-proBNP ≥ 125 ng/L), and controls (<i>n</i> = 30, no pAF and NT-proBNP < 125 ng/L). NT-proBNP was not associated with structural (left atrial volume and left ventricular (LV) mass) or functional (E/e', LV strain) alterations in any group (<i>p</i> > 0.05). Cardiovascular risk factors (HR: 4.6; CI = 1.7-12.3; <i>p</i> = 0.002), but not NT-proBNP (HR: 1.9; CI = 0.7-5.1; <i>p</i> = 0.2), entailed a prognostic value for the composite endpoint of HF, AF, and cardiovascular death. <b>Conclusions:</b> In septuagenarians without HF, modest NT-proBNP elevation was not associated with echocardiographic changes or prognosis.