Umair Khalid1, Lisa Miller Wruck2, Pedro Miguel Quibrera2, Biykem Bozkurt3, Vijay Nambi3, Salim S Virani3, Hani Jneid3, Sunil Agarwal4, Patricia P Chang5, Laura Loehr6, Sukhdeep Singh Basra1, Wayne Rosamond6, Christie M Ballantyne1, Anita Deswal7. 1. Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States. 2. Department of Biostatistics, University of North Carolina, Chapel Hill, NC, United States. 3. Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States; Section of Cardiology, Michael E. DeBakey VA Medical Center, Houston, TX, United States. 4. Department of Medicine, Johns Hopkins University, Baltimore, MD, United States. 5. Department of Medicine, University of North Carolina, Chapel Hill, NC, United States. 6. Department of Epidemiology, University of North Carolina, Chapel Hill, NC, United States. 7. Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States; Section of Cardiology, Michael E. DeBakey VA Medical Center, Houston, TX, United States. Electronic address: adeswal@bcm.edu.
Abstract
BACKGROUND: Levels of B-type natriuretic peptide (BNP), a prognostic marker in patients with heart failure (HF), are lower among HF patients with obesity or preserved Left Ventricular Ejection Fraction (LVEF). We examined the distribution and prognostic value of BNP across BMI categories in acute decompensated heart failure (ADHF) patients with preserved vs. reduced LVEF. METHODS: We analyzed data from the Atherosclerosis Risk in Communities (ARIC) HF surveillance study which sampled and adjudicated ADHF hospitalizations in patients aged ≥55years from 4 US communities (2005-2009). We examined 5 BMI categories: underweight (<18.5kg/m2), normal weight (18.5-<25), overweight (25-<30), obese (30-<40) and morbidly obese (≥40) in HF with preserved LVEF (HFpEF) and reduced LVEF (HFrEF). The outcome was 1-year mortality from admission. We used ANCOVA to model log BNP and logistic regression for 1-year mortality, both adjusted for demographics and clinical characteristics. RESULTS: The cohort included 9820 weighted ADHF hospitalizations (58% HFrEF; 42% HFpEF). BNP levels were lower in HFpEF compared to HFrEF (p<0.001) and decreased as BMI increased within the LVEF groups (p<0.001). After adjustment for covariates, log10 BNP independently predicted 1-year mortality (adjusted OR 1.62 (95% CI 1.17-2.24)) with no significant interaction by BMI or LVEF groups. CONCLUSIONS: BNP levels correlated inversely with BMI, and were higher in HFrEF compared to HFpEF. Obese patients with HFpEF and ADHF had a significant proportion with BNP levels below clinically accepted thresholds. Nevertheless, BNP was a predictor of mortality in ADHF across groups of BMI in HFpEF and HFrEF. Published by Elsevier B.V.
BACKGROUND: Levels of B-type natriuretic peptide (BNP), a prognostic marker in patients with heart failure (HF), are lower among HF patients with obesity or preserved Left Ventricular Ejection Fraction (LVEF). We examined the distribution and prognostic value of BNP across BMI categories in acute decompensated heart failure (ADHF) patients with preserved vs. reduced LVEF. METHODS: We analyzed data from the Atherosclerosis Risk in Communities (ARIC) HF surveillance study which sampled and adjudicated ADHF hospitalizations in patients aged ≥55years from 4 US communities (2005-2009). We examined 5 BMI categories: underweight (<18.5kg/m2), normal weight (18.5-<25), overweight (25-<30), obese (30-<40) and morbidly obese (≥40) in HF with preserved LVEF (HFpEF) and reduced LVEF (HFrEF). The outcome was 1-year mortality from admission. We used ANCOVA to model log BNP and logistic regression for 1-year mortality, both adjusted for demographics and clinical characteristics. RESULTS: The cohort included 9820 weighted ADHF hospitalizations (58% HFrEF; 42% HFpEF). BNP levels were lower in HFpEF compared to HFrEF (p<0.001) and decreased as BMI increased within the LVEF groups (p<0.001). After adjustment for covariates, log10 BNP independently predicted 1-year mortality (adjusted OR 1.62 (95% CI 1.17-2.24)) with no significant interaction by BMI or LVEF groups. CONCLUSIONS:BNP levels correlated inversely with BMI, and were higher in HFrEF compared to HFpEF. Obesepatients with HFpEF and ADHF had a significant proportion with BNP levels below clinically accepted thresholds. Nevertheless, BNP was a predictor of mortality in ADHF across groups of BMI in HFpEF and HFrEF. Published by Elsevier B.V.
Entities:
Keywords:
B-type natriuretic peptide; Body mass index; Heart failure; Obesity
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