Giuseppe Vergaro1, Francesco Gentile2, Laura M G Meems3, Alberto Aimo4, James L Januzzi5, A Mark Richards6, Carolyn S P Lam7, Roberto Latini8, Lidia Staszewsky8, Inder S Anand9, Jay N Cohn10, Thor Ueland11, Lars Gullestad12, Pål Aukrust13, Hans-Peter Brunner-La Rocca14, Antoni Bayes-Genis15, Josep Lupón15, Akiomi Yoshihisa16, Yasuchika Takeishi16, Michael Egstrup17, Ida Gustafsson17, Hanna K Gaggin18, Kai M Eggers19, Kurt Huber20, Greg D Gamble21, Lieng H Ling22, Kui Tong Gerard Leong23, Poh Shuah Daniel Yeo24, Hean Yee Ong25, Fazlur Jaufeerally26, Tze P Ng22, Richard Troughton5, Robert N Doughty21, Gerry Devlin27, Mayanna Lund28, Alberto Giannoni29, Claudio Passino29, Rudolf A de Boer3, Michele Emdin29. 1. Scuola Superiore Sant'Anna, Pisa, Italy; Fondazione Toscana G. Monasterio, Pisa, Italy. Electronic address: vergaro@ftgm.it. 2. Fondazione Toscana G. Monasterio, Pisa, Italy. 3. University Medical Centre Groningen, Groningen, the Netherlands. 4. Scuola Superiore Sant'Anna, Pisa, Italy. 5. Massachusetts General Hospital and Baim Institute for Clinical Research, Boston, Massachusetts, USA. 6. University of Otago, Dunedin, New Zealand. 7. National Heart Centre Singapore and Duke-National University of Singapore, Singapore. 8. IRCCS-Istituto di Ricerche Farmacologiche-"Mario Negri," IRCCS Milano, Italy. 9. University of Minnesota, Minneapolis, Minnesota, USA; VA Medical Centre, Minneapolis, Minnesota, USA. 10. University of Minnesota, Minneapolis, Minnesota, USA. 11. Oslo University Hospital, Ullevål, Oslo, Norway; Oslo University Hospital, Rikshospitalet, Oslo, Norway; University of Oslo, Oslo, Norway; University of Tromsø, Tromsø, Norway. 12. KG Jebsen Center for Cardiac Research, University of Oslo, and Center for Heart Failure Research, Oslo University Hospital, Oslo, Norway. 13. Oslo University Hospital, Rikshospitalet, Oslo, Norway; University of Oslo, Oslo, Norway. 14. Maastricht University Medical Centre, Maastricht, the Netherlands. 15. Hospital Universitari Germans Trias i Pujol, Badalona (Barcelona) and CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain. 16. Fukushima Medical University, Fukushima, Japan. 17. Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark. 18. Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA. 19. Uppsala University, Uppsala, Sweden. 20. Wilhelminenspital and Sigmund Freud University Medical School, Vienna, Austria. 21. University of Auckland, Auckland, New Zealand. 22. National University Heart Centre and National University of Singapore, Singapore. 23. Changi General Hospital, Singapore. 24. Tan Tock Seng Hospital, Singapore. 25. Khoo Teck Puat Hospital, Singapore. 26. Singapore General Hospital, Singapore. 27. Gisborne Hospital, Gisborne, New Zealand. 28. Middlemore Hospital, Auckland, New Zealand. 29. Scuola Superiore Sant'Anna, Pisa, Italy; Fondazione Toscana G. Monasterio, Pisa, Italy.
Abstract
OBJECTIVES: The goal of this study was to assess the predictive power of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and the decision cutoffs in heart failure (HF) across body mass index (BMI) categories. BACKGROUND: Concentrations of NT-proBNP predict outcome in HF. Although the influence of BMI to reduce levels of NT-proBNP is known, the impact of obesity on prognostic value remains uncertain. METHODS: Individual data from the BIOS (Biomarkers In Heart Failure Outpatient Study) consortium were analyzed. Patients with stable HF were classified as underweight (BMI <18.5 kg/m2), normal weight (BMI 18.5-24.9 kg/m2), overweight (BMI 25-29.9 kg/m2), and mildly (BMI 30-34.9 kg/m2), moderately (BMI 35-39.9 kg/m2), or severely (BMI ≥40 kg/m2) obese. The prognostic role of NT-proBNP was tested for the endpoints of all-cause and cardiac death. RESULTS: The study population included 12,763 patients (mean age 66 ± 12 years; 25% women; mean left ventricular ejection fraction 33% ± 13%). Most patients were overweight (n = 5,176), followed by normal weight (n = 4,299), mildly obese (n = 2,157), moderately obese (n = 612), severely obese (n = 314), and underweight (n = 205). NT-proBNP inversely correlated with BMI (β = -0.174 for 1 kg/m2; P < 0.001). Adding NT-proBNP to clinical models improved risk prediction across BMI categories, with the exception of severely obese patients. The best cutoffs of NT-proBNP for 5-year all-cause death prediction were lower as BMI increased (3,785 ng/L, 2,193 ng/L, 1,554 ng/L, 1,045 ng/L, 755 ng/L, and 879 ng/L, for underweight, normal weight, overweight, and mildly, moderately, and severely obese patients, respectively) and were higher in women than in men. CONCLUSIONS: NT-proBNP maintains its independent prognostic value up to 40 kg/m2 BMI, and lower optimal risk-prediction cutoffs are observed in overweight and obese patients.
OBJECTIVES: The goal of this study was to assess the predictive power of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and the decision cutoffs in heart failure (HF) across body mass index (BMI) categories. BACKGROUND: Concentrations of NT-proBNP predict outcome in HF. Although the influence of BMI to reduce levels of NT-proBNP is known, the impact of obesity on prognostic value remains uncertain. METHODS: Individual data from the BIOS (Biomarkers In Heart Failure Outpatient Study) consortium were analyzed. Patients with stable HF were classified as underweight (BMI <18.5 kg/m2), normal weight (BMI 18.5-24.9 kg/m2), overweight (BMI 25-29.9 kg/m2), and mildly (BMI 30-34.9 kg/m2), moderately (BMI 35-39.9 kg/m2), or severely (BMI ≥40 kg/m2) obese. The prognostic role of NT-proBNP was tested for the endpoints of all-cause and cardiac death. RESULTS: The study population included 12,763 patients (mean age 66 ± 12 years; 25% women; mean left ventricular ejection fraction 33% ± 13%). Most patients were overweight (n = 5,176), followed by normal weight (n = 4,299), mildly obese (n = 2,157), moderately obese (n = 612), severely obese (n = 314), and underweight (n = 205). NT-proBNP inversely correlated with BMI (β = -0.174 for 1 kg/m2; P < 0.001). Adding NT-proBNP to clinical models improved risk prediction across BMI categories, with the exception of severely obese patients. The best cutoffs of NT-proBNP for 5-year all-cause death prediction were lower as BMI increased (3,785 ng/L, 2,193 ng/L, 1,554 ng/L, 1,045 ng/L, 755 ng/L, and 879 ng/L, for underweight, normal weight, overweight, and mildly, moderately, and severely obese patients, respectively) and were higher in women than in men. CONCLUSIONS: NT-proBNP maintains its independent prognostic value up to 40 kg/m2 BMI, and lower optimal risk-prediction cutoffs are observed in overweight and obese patients.
Authors: Giuseppe Vergaro; Francesco Gentile; Alberto Aimo; James L Januzzi; A Mark Richards; Carolyn S P Lam; Rudolf A de Boer; Laura M G Meems; Roberto Latini; Lidia Staszewsky; Inder S Anand; Jay N Cohn; Thor Ueland; Lars Gullestad; Pål Aukrust; Hans-Peter Brunner-La Rocca; Antoni Bayes-Genis; Josep Lupón; Akiomi Yoshihisa; Yasuchika Takeishi; Michael Egstrup; Ida Gustafsson; Hanna K Gaggin; Kai M Eggers; Kurt Huber; Greg D Gamble; Lieng H Ling; Kui Toh Gerard Leong; Poh Shuah Daniel Yeo; Hean Yee Ong; Fazlur Jaufeerally; Tze P Ng; Richard Troughton; Robert N Doughty; Gerry Devlin; Mayanna Lund; Alberto Giannoni; Claudio Passino; Michele Emdin Journal: ESC Heart Fail Date: 2022-05-05