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NT-proBNP for Risk Prediction in Heart Failure : Identification of Optimal Cutoffs Across Body Mass Index Categories

Vergaro, Giuseppe (author)
Scuola Super Sant Anna, Pisa, Italy; Fdn Toscana G Monasterio, Pisa, Italy
Gentile, Francesco (author)
Fdn Toscana G Monasterio, Pisa, Italy
Meems, Laura M. G. (author)
Univ Med Ctr Groningen, Groningen, Netherlands
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Aimo, Alberto (author)
Scuola Super Sant Anna, Pisa, Italy
Januzzi Jr., James L. (author)
Massachusetts Gen Hosp, Boston, MA 02114 USA; Baim Inst Clin Res, Boston, MA USA
Richards, A. Mark (author)
Univ Otago, Dunedin, New Zealand
Lam, Carolyn S. P. (author)
Natl Heart Ctr Singapore, Singapore, Singapore; Duke Natl Univ Singapore, Singapore, Singapore
Latini, Roberto (author)
IRCCS Milano, IRCCS Ist Ric Farmacol Mario Negri, Milan, Italy
Staszewsky, Lidia (author)
IRCCS Milano, IRCCS Ist Ric Farmacol Mario Negri, Milan, Italy
Anand, Inder S. (author)
Univ Minnesota, Minneapolis, MN USA; VA Med Ctr, Minneapolis, MN USA
Cohn, Jay N. (author)
Univ Minnesota, Minneapolis, MN USA
Ueland, Thor (author)
Oslo Univ Hosp, Oslo, Norway; Oslo Univ Hosp, Rigshosp, Oslo, Norway; Univ Oslo, Oslo, Norway; Univ Tromso, Tromso, Norway
Gullestad, Lars (author)
Univ Oslo, KG Jebsen Ctr Cardiac Res, Oslo, Norway; Oslo Univ Hosp, Ctr Heart Failure Res, Oslo, Norway
Aukrust, Pål (author)
Oslo Univ Hosp, Rigshosp, Oslo, Norway; Univ Oslo, Oslo, Norway
Brunner-La Rocca, Hans-Peter (author)
Maastricht Univ, Med Ctr, Maastricht, Netherlands
Bayes-Genis, Antoni (author)
Hosp Badalona Germans Trias & Pujol, Badalona, Barcelona, Spain; Inst Salud Carlos III, CIBER Cardiovasc, Madrid, Spain
Lupón, Josep (author)
Hosp Badalona Germans Trias & Pujol, Badalona, Barcelona, Spain; Inst Salud Carlos III, CIBER Cardiovasc, Madrid, Spain
Yoshihisa, Akiomi (author)
Fukushima Med Univ, Fukushima, Japan
Takeishi, Yasuchika (author)
Fukushima Med Univ, Fukushima, Japan
Egstrup, Michael (author)
Copenhagen Univ Hosp, Rigshosp, Copenhagen, Denmark
Gustafsson, Ida (author)
Copenhagen Univ Hosp, Rigshosp, Copenhagen, Denmark
Gaggin, Hanna K. (author)
Massachusetts Gen Hosp, Boston, MA 02114 USA; Harvard Med Sch, Boston, MA 02115 USA
Eggers, Kai M., 1962- (author)
Uppsala universitet,Uppsala kliniska forskningscentrum (UCR),Kardiologi
Huber, Kurt (author)
Wilhelminenspital Stadt Wien, Vienna, Austria; Sigmund Freud Univ, Med Sch, Vienna, Austria
Gamble, Greg D. (author)
Univ Auckland, Auckland, New Zealand
Ling, Lieng H. (author)
Natl Univ Heart Ctr, Singapore, Singapore; Natl Univ Singapore, Singapore, Singapore
Leong, Kui Tong Gerard (author)
Changi Gen Hosp, Singapore, Singapore
Yeo, Poh Shuah Daniel (author)
Tan Tock Seng Hosp, Singapore, Singapore
Ong, Hean Yee (author)
Khoo Teck Puat Hosp, Singapore, Singapore
Jaufeerally, Fazlur (author)
Singapore Gen Hosp, Singapore, Singapore
Ng, Tze P. (author)
Natl Univ Heart Ctr, Singapore, Singapore; Natl Univ Singapore, Singapore, Singapore
Troughton, Richard (author)
Massachusetts Gen Hosp, Boston, MA 02114 USA; Baim Inst Clin Res, Boston, MA USA
Doughty, Robert N. (author)
Univ Auckland, Auckland, New Zealand
Devlin, Gerry (author)
Gisborne Hosp, Gisborne, New Zealand
Lund, Mayanna (author)
Middlemore Hosp, Auckland, New Zealand
Giannoni, Alberto (author)
Scuola Super Sant Anna, Pisa, Italy; Fdn Toscana G Monasterio, Pisa, Italy
Passino, Claudio (author)
Scuola Super Sant Anna, Pisa, Italy; Fdn Toscana G Monasterio, Pisa, Italy
Boer, Rudolf A. de (author)
Univ Med Ctr Groningen, Groningen, Netherlands
Emdin, Michele (author)
Scuola Super Sant Anna, Pisa, Italy; Fdn Toscana G Monasterio, Pisa, Italy
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 (creator_code:org_t)
American College of Cardiology, 2021
2021
English.
In: JACC. Heart failure. - : American College of Cardiology. - 2213-1779 .- 2213-1787. ; 9:9, s. 653-663
  • Journal article (peer-reviewed)
Abstract Subject headings
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  • ObjectivesThe 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.BackgroundConcentrations 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.MethodsIndividual 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.ResultsThe 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.ConclusionsNT-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.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kardiologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)

Keyword

body mass index
chronic heart failure
NT-proBNP
obesity
outcome

Publication and Content Type

ref (subject category)
art (subject category)

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