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J Am Heart Assoc. 2018 Feb 3;7(3). pii: e006740. doi: 10.1161/JAHA.117.006740.

Interaction of Body Mass Index on the Association Between N-Terminal-Pro-b-Type Natriuretic Peptide and Morbidity and Mortality in Patients With Acute Heart Failure: Findings From ASCEND-HF (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure).

Author information

1
Department of Medicine, Duke University Medical Center, Durham, NC.
2
Inova Heart & Vascular Institute, Falls Church, VA.
3
Duke Clinical Research Institute, Durham, NC.
4
Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH.
5
Piedmont Heart Institute, Atlanta, GA.
6
Stony Brook Heart Institute, Stony Brook, NY.
7
Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada.
8
Department of Medicine, Duke University Medical Center, Durham, NC robert.mentz@duke.edu.

Abstract

BACKGROUND:

Higher body mass index (BMI) is associated with lower circulating levels of N-terminal-pro-b-type natriuretic peptide (NT-proBNP). The Interaction between BMI and NT-proBNP with respect to clinical outcomes is not well characterized in patients with acute heart failure.

METHODS AND RESULTS:

A total of 686 patients from the biomarker substudy of the ASCEND-HF (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated HF ) clinical trial with documented NT-proBNP levels at baseline were included in the present analysis. Patients were classified by the World Health Organization obesity classification (nonobese: BMI <30 kg/m2, Class I obesity: BMI 30-34.9 kg/m2, Class II obesity BMI 35-39.9 kg/m2, and Class III obesity BMI ≥40 kg/m2). We assessed baseline characteristics and 30- and 180-day outcomes by BMI class and explored the interaction between BMI and NT-proBNP for these outcomes. Study participants had a median age of 67 years (55, 78) and 71% were female. NT-proBNP levels were inversely correlated with BMI (P<0.001). Higher NT-proBNP levels were associated with higher 180-day mortality (adjusted hazard ratio for each doubling of NT-proBNP, 1.40; 95% confidence interval, 1.16, 1.71; P<0.001), but not 30-day outcomes. The effect of NT-proBNP on 180-day death was not modified by BMI class (interaction P=0.24).

CONCLUSIONS:

The prognostic value of NT-proBNP was not modified by BMI in this acute heart failure population. NT-proBNP remains a useful prognostic indicator of long-term mortality in acute heart failure even in the obese patient.

CLINICAL TRIAL REGISTRATION:

URL: http://www.clinicaltrials.gov. Unique identifier: NCT00475852.

KEYWORDS:

N‐terminal‐pro‐b‐type natriuretic peptide; Obesity; acute heart failure; body mass index

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