NT-proBNP for Risk Prediction in Heart Failure Identification of Optimal Cutoffs Across Body Mass Index Categories
Por:
Vergaro, G, Gentile, F, Meems, LMG, Aimo, A, Januzzi, JL, Richards, AM, Lam, CSP, Latini, R, Staszewsky, L, Anand, IS, Cohn, JN, Ueland, T, Gullestad, L, Aukrust, P, Brunner-La Rocca, HP, Bayes-Genis, A, Lupon, J, Yoshihisa, A, Takeishi, Y, Egstrup, M, Gustafsson, I, Gaggin, HK, Eggers, KM, Huber, K, Gamble, GD, Ling, LH, Leong, KTG, Yeo, PSD, Ong, HY, Jaufeerally, L, Ng, TP, Troughton, R, Doughty, RN, Devlin, G, Lund, M, Giannoni, A, Passino, C, de Boer, RA and Emdin, M
Publicada:
1 sep 2021
Ahead of Print:
1 ago 2021
Resumen:
OBJECTIVES The goat 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/m(2)), normal weight (BMI 18.5-24.9 kg/m(2)), overweight (BMI 25-29.9 kg/m(2)), and mildly (BMI 30-34.9 kg/m(2)), moderately (BMI 35-39.9 kg/m(2)), or severely (BMI >= 40 kg/m(2)) obese. The prognostic rote 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% 113%). 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 (beta = -0.174 for 1 kg/m(2); 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/m(2) BMI, and tower optimal risk-prediction cutoffs are observed in overweight and obese patients. (C) 2021 by the American College of Cardiology Foundation.
Filiaciones:
Vergaro, G:
Scuola Super Sant Anna, Pisa, Italy
Fdn Toscana G Monasterio, Pisa, Italy
Gentile, F:
Fdn Toscana G Monasterio, Pisa, Italy
Meems, LMG:
Univ Med Ctr Groningen, Groningen, Netherlands
Aimo, A:
Scuola Super Sant Anna, Pisa, Italy
Januzzi, JL:
Massachusetts Gen Hosp, Boston, MA 02114 USA
Baim Inst Clin Res, Boston, MA USA
Richards, AM:
Univ Otago, Dunedin, New Zealand
Lam, CSP:
Natl Heart Ctr Singapore, Singapore, Singapore
Duke Natl Univ Singapore, Singapore, Singapore
Latini, R:
IRCCS Milano, IRCCS Ist Ric Farmacol Mario Negri, Milan, Italy
Staszewsky, L:
IRCCS Milano, IRCCS Ist Ric Farmacol Mario Negri, Milan, Italy
Anand, IS:
Univ Minnesota, Minneapolis, MN USA
VA Med Ctr, Minneapolis, MN USA
Cohn, JN:
Univ Minnesota, Minneapolis, MN USA
Ueland, T:
Oslo Univ Hosp, Oslo, Norway
Oslo Univ Hosp, Rigshosp, Oslo, Norway
Univ Oslo, Oslo, Norway
Univ Tromso, Tromso, Norway
Gullestad, L:
Univ Oslo, KG Jebsen Ctr Cardiac Res, Oslo, Norway
Oslo Univ Hosp, Ctr Heart Failure Res, Oslo, Norway
Aukrust, P:
Oslo Univ Hosp, Rigshosp, Oslo, Norway
Univ Oslo, Oslo, Norway
Brunner-La Rocca, HP:
Maastricht Univ, Med Ctr, Maastricht, Netherlands
:
Hosp Badalona Germans Trias & Pujol, Badalona, Barcelona, Spain
Inst Salud Carlos III, CIBER Cardiovasc, Madrid, Spain
:
Hosp Badalona Germans Trias & Pujol, Badalona, Barcelona, Spain
Inst Salud Carlos III, CIBER Cardiovasc, Madrid, Spain
Yoshihisa, A:
Fukushima Med Univ, Fukushima, Japan
Takeishi, Y:
Fukushima Med Univ, Fukushima, Japan
Egstrup, M:
Copenhagen Univ Hosp, Rigshosp, Copenhagen, Denmark
Gustafsson, I:
Copenhagen Univ Hosp, Rigshosp, Copenhagen, Denmark
Gaggin, HK:
Massachusetts Gen Hosp, Boston, MA 02114 USA
Harvard Med Sch, Boston, MA 02115 USA
Eggers, KM:
Uppsala Univ, Uppsala, Sweden
Huber, K:
Wilhelminenspital Stadt Wien, Vienna, Austria
Sigmund Freud Univ, Med Sch, Vienna, Austria
Gamble, GD:
Univ Auckland, Auckland, New Zealand
Ling, LH:
Natl Univ Heart Ctr, Singapore, Singapore
Natl Univ Singapore, Singapore, Singapore
Leong, KTG:
Changi Gen Hosp, Singapore, Singapore
Yeo, PSD:
Tan Tock Seng Hosp, Singapore, Singapore
Ong, HY:
Khoo Teck Puat Hosp, Singapore, Singapore
Jaufeerally, L:
Singapore Gen Hosp, Singapore, Singapore
Ng, TP:
Natl Univ Heart Ctr, Singapore, Singapore
Natl Univ Singapore, Singapore, Singapore
Troughton, R:
Massachusetts Gen Hosp, Boston, MA 02114 USA
Baim Inst Clin Res, Boston, MA USA
Doughty, RN:
Univ Auckland, Auckland, New Zealand
Devlin, G:
Gisborne Hosp, Gisborne, New Zealand
Lund, M:
Middlemore Hosp, Auckland, New Zealand
Giannoni, A:
Scuola Super Sant Anna, Pisa, Italy
Fdn Toscana G Monasterio, Pisa, Italy
Passino, C:
Scuola Super Sant Anna, Pisa, Italy
Fdn Toscana G Monasterio, Pisa, Italy
de Boer, RA:
Univ Med Ctr Groningen, Groningen, Netherlands
Emdin, M:
Scuola Super Sant Anna, Pisa, Italy
Fdn Toscana G Monasterio, Pisa, Italy
Green Published
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