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. 2021 Sep;9(9):653-663.
doi: 10.1016/j.jchf.2021.05.014. Epub 2021 Jul 7.

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

Giuseppe Vergaro  1 , Francesco Gentile  2 , Laura M G Meems  3 , Alberto Aimo  4 , James L Januzzi Jr  5 , A Mark Richards  6 , Carolyn S P Lam  7 , Roberto Latini  8 , Lidia Staszewsky  8 , Inder S Anand  9 , Jay N Cohn  10 , Thor Ueland  11 , Lars Gullestad  12 , Pål Aukrust  13 , Hans-Peter Brunner-La Rocca  14 , Antoni Bayes-Genis  15 , Josep Lupón  15 , Akiomi Yoshihisa  16 , Yasuchika Takeishi  16 , Michael Egstrup  17 , Ida Gustafsson  17 , Hanna K Gaggin  18 , Kai M Eggers  19 , Kurt Huber  20 , Greg D Gamble  21 , Lieng H Ling  22 , Kui Tong Gerard Leong  23 , Poh Shuah Daniel Yeo  24 , Hean Yee Ong  25 , Fazlur Jaufeerally  26 , Tze P Ng  22 , Richard Troughton  5 , Robert N Doughty  21 , Gerry Devlin  27 , Mayanna Lund  28 , Alberto Giannoni  29 , Claudio Passino  29 , Rudolf A de Boer  3 , Michele Emdin  29
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Free article

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

Giuseppe Vergaro et al. JACC Heart Fail. 2021 Sep.
Free article

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: NT-proBNP; body mass index; chronic heart failure; obesity; outcome.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Januzzi is supported in part by the Hutter Family Professorship; is a Trustee of the American College of Cardiology; has received grant support from Novartis Pharmaceuticals, Roche Diagnostics, Abbott, Singulex and Prevencio; has received consulting income from Abbott, Janssen, Novartis, Pfizer, Merck, and Roche Diagnostics; and participates in clinical endpoint committees/data safety monitoring boards for Abbott, AbbVie, Amgen, Boehringer Ingelheim, Janssen, and Takeda. Dr Richards has sat on advisory boards and/or received speakers honoraria, travel support, and/or grants from Novartis, Roche Diagnostics, Abbott Laboratories, Thermo Fisher, and Critical Diagnostics. Dr Lam is supported by a Clinician Scientist Award from the National Medical Research Council of Singapore; has received research support from Boston Scientific, Bayer, Roche Diagnostics, AstraZeneca, Medtronic, and Vifor Pharma; has served as consultant or on the Advisory Board/ Steering Committee/Executive Committee for Boston Scientific, Bayer, Roche Diagnostics, AstraZeneca, Medtronic, Vifor Pharma, Novartis, Amgen, Merck, Janssen Research & Development LLC, Menarini, Boehringer Ingelheim, Novo Nordisk, Abbott Diagnostics, Corvia, Stealth BioTherapeutics, JanaCare, Biofourmis, Darma, Applied Therapeutics, MyoKardia, WebMD Global LLC, Radcliffe Group Ltd, and Corpus. Dr Latini has received grant support and travel reimbursements from Roche Diagnostics. Dr Brunner-La Rocca reports unrestricted research grants and consulting fees from Roche Diagnostics, as well as unrestricted research grants from Novartis and GlaxoSmithKline outside this work. Dr Bayes-Genis has received grant support from Roche Diagnosis, lecture honoraria from Roche Diagnostics and Critical Diagnostics, and consulting income from Roche Diagnostics, Critical Diagnostics, and Novartis. Dr Lupón has received lecture honoraria from Roche Diagnostics and Critical Diagnostics. The University Medical Centre Groningen, which employs Drs De Boer and Meems, has received research grants and/or fees from AstraZeneca, Abbott, Boehringer Ingelheim, Cardior Pharmaceuticals Gmbh, Ionis Pharmaceuticals, Inc, Novo Nordisk, and Roche. Dr de Boer received speaker fees from Abbott, AstraZeneca, Bayer, Novartis, and Roche, outside the submitted work. Dr Gaggin has received grant support from Roche and Portola; consulting income from Roche Diagnostics, Amgen, and Ortho Clinical; and research payments for clinical endpoint committees for EchoSense and Radiometer. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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