BNP and obesity in acute decompensated heart failure with preserved vs. reduced ejection fraction: The Atherosclerosis Risk in Communities Surveillance Study

INTERNATIONAL JOURNAL OF CARDIOLOGY

卷:233

Article

Khalid, Umair¹  Wruck, Lisa Miller²  Quibrera, Pedro Miguel²  Bozkurt, Biykem^1,4  Nambi, Vijay^1,4  Virani, Salim S.^1,4  Jneid, Hani^1,4  Agarwal, Sunil⁵  Chang, Patricia P.⁶  Loehr, Laura³  Basra, Sukhdeep Singh¹  Rosamond, Wayne³  Ballantyne, Christie M.¹  Deswal, Anita^1,4 

[1] Baylor Coll Med, Dept Med, Sect Cardiol, Houston, TX 77030 USA

[2] Univ N Carolina, Dept Biostat, Chapel Hill, NC USA

[3] Univ N Carolina, Dept Epidemiol, Chapel Hill, NC USA

[4] Michael E DeBakey VA Med Ctr, Sect Cardiol, Houston, TX USA

[5] Johns Hopkins Univ, Dept Med, Baltimore, MD USA

[6] Univ N Carolina, Dept Med, Chapel Hill, NC USA

关键词: B-type natriuretic peptide;    Heart failure;    Obesity;    Body mass index;   

DOI  :  10.1016/j.ijcard.2017.01.130

来源: Elsevier

【 摘 要 】

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 >= 55 years from 4 US communities (2005-2009). We examined 5 BMI categories: underweight (< 18.5 kg/m(2)), 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 Ireland Ltd.

【 授权许可】

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