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

Giuseppe Vergaro; Francesco Gentile; Laura M G Meems; Alberto Aimo; James L Januzzi; A Mark Richards; Carolyn S P Lam; 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 Tong 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; Rudolf A de Boer; Michele Emdin

doi:10.1016/j.jchf.2021.05.014

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

Giuseppe Vergaro, Francesco Gentile, Laura M G Meems, Alberto Aimo, James L Januzzi, A Mark Richards, Carolyn S P Lam, 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 EgstrupIda Gustafsson, Hanna K Gaggin, Kai M Eggers, Kurt Huber, Greg D Gamble, Lieng H Ling, Kui Tong 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, Rudolf A de Boer, Michele Emdin

Hjerteafdelingen BFH

52 Citationer (Scopus)

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.

Originalsprog	Engelsk
Tidsskrift	JACC. Heart failure
Vol/bind	9
Udgave nummer	9
Sider (fra-til)	653-663
Antal sider	11
ISSN	2213-1779
DOI	https://doi.org/10.1016/j.jchf.2021.05.014
Status	Udgivet - sep. 2021

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10.1016/j.jchf.2021.05.014

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Vergaro, G., Gentile, F., Meems, L. M. G., Aimo, A., Januzzi, J. L., Richards, A. M., Lam, C. S. P., Latini, R., Staszewsky, L., Anand, I. S., Cohn, J. N., Ueland, T., Gullestad, L., Aukrust, P., Brunner-La Rocca, H.-P., Bayes-Genis, A., Lupón, J., Yoshihisa, A., Takeishi, Y., ... Emdin, M. (2021). NT-proBNP for Risk Prediction in Heart Failure: Identification of Optimal Cutoffs Across Body Mass Index Categories. JACC. Heart failure, 9(9), 653-663. https://doi.org/10.1016/j.jchf.2021.05.014

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, H-P, Bayes-Genis, A, Lupón, 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, F, Ng, TP, Troughton, R, Doughty, RN, Devlin, G, Lund, M, Giannoni, A, Passino, C, de Boer, RA & Emdin, M 2021, 'NT-proBNP for Risk Prediction in Heart Failure: Identification of Optimal Cutoffs Across Body Mass Index Categories', JACC. Heart failure, bind 9, nr. 9, s. 653-663. https://doi.org/10.1016/j.jchf.2021.05.014

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

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.",

keywords = "Aged, Biomarkers, Body Mass Index, Female, Heart Failure, Humans, Male, Middle Aged, Natriuretic Peptide, Brain, Peptide Fragments, Prognosis, Stroke Volume, Ventricular Function, Left, body mass index, chronic heart failure, NT-proBNP, obesity, outcome",

author = "Giuseppe Vergaro and Francesco Gentile and Meems, {Laura M G} and Alberto Aimo and Januzzi, {James L} and Richards, {A Mark} and Lam, {Carolyn S P} and Roberto Latini and Lidia Staszewsky and Anand, {Inder S} and Cohn, {Jay N} and Thor Ueland and Lars Gullestad and P{\aa}l Aukrust and {Brunner-La Rocca}, Hans-Peter and Antoni Bayes-Genis and Josep Lup{\'o}n and Akiomi Yoshihisa and Yasuchika Takeishi and Michael Egstrup and Ida Gustafsson and Gaggin, {Hanna K} and Eggers, {Kai M} and Kurt Huber and Gamble, {Greg D} and Ling, {Lieng H} and Leong, {Kui Tong Gerard} and Yeo, {Poh Shuah Daniel} and Ong, {Hean Yee} and Fazlur Jaufeerally and Ng, {Tze P} and Richard Troughton and Doughty, {Robert N} and Gerry Devlin and Mayanna Lund and Alberto Giannoni and Claudio Passino and {de Boer}, {Rudolf A} and Michele Emdin",

year = "2021",

month = sep,

doi = "10.1016/j.jchf.2021.05.014",

language = "English",

volume = "9",

pages = "653--663",

journal = "JACC. Heart failure",

issn = "2213-1779",

publisher = "Elsevier Inc.",

number = "9",

}

TY - JOUR

T1 - NT-proBNP for Risk Prediction in Heart Failure

T2 - Identification of Optimal Cutoffs Across Body Mass Index Categories

AU - Vergaro, Giuseppe

AU - Gentile, Francesco

AU - Meems, Laura M G

AU - Aimo, Alberto

AU - Januzzi, James L

AU - Richards, A Mark

AU - Lam, Carolyn S P

AU - Latini, Roberto

AU - Staszewsky, Lidia

AU - Anand, Inder S

AU - Cohn, Jay N

AU - Ueland, Thor

AU - Gullestad, Lars

AU - Aukrust, Pål

AU - Brunner-La Rocca, Hans-Peter

AU - Bayes-Genis, Antoni

AU - Lupón, Josep

AU - Yoshihisa, Akiomi

AU - Takeishi, Yasuchika

AU - Egstrup, Michael

AU - Gustafsson, Ida

AU - Gaggin, Hanna K

AU - Eggers, Kai M

AU - Huber, Kurt

AU - Gamble, Greg D

AU - Ling, Lieng H

AU - Leong, Kui Tong Gerard

AU - Yeo, Poh Shuah Daniel

AU - Ong, Hean Yee

AU - Jaufeerally, Fazlur

AU - Ng, Tze P

AU - Troughton, Richard

AU - Doughty, Robert N

AU - Devlin, Gerry

AU - Lund, Mayanna

AU - Giannoni, Alberto

AU - Passino, Claudio

AU - de Boer, Rudolf A

AU - Emdin, Michele

PY - 2021/9

Y1 - 2021/9

N2 - 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.

AB - 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.

KW - Aged

KW - Biomarkers

KW - Body Mass Index

KW - Female

KW - Heart Failure

KW - Humans

KW - Male

KW - Middle Aged

KW - Natriuretic Peptide, Brain

KW - Peptide Fragments

KW - Prognosis

KW - Stroke Volume

KW - Ventricular Function, Left

KW - body mass index

KW - chronic heart failure

KW - NT-proBNP

KW - obesity

KW - outcome

UR - http://www.scopus.com/inward/record.url?scp=85113776411&partnerID=8YFLogxK

U2 - 10.1016/j.jchf.2021.05.014

DO - 10.1016/j.jchf.2021.05.014

M3 - Journal article

C2 - 34246607

SN - 2213-1779

VL - 9

SP - 653

EP - 663

JO - JACC. Heart failure

JF - JACC. Heart failure

IS - 9

ER -

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

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