Highest Obesity Category Associated With Largest Decrease in N-Terminal Pro-B-Type Natriuretic Peptide in Patients Hospitalized With Heart Failure With Preserved Ejection Fraction.
Highest Obesity Category Associated With Largest Decrease in N-Terminal Pro-B-Type Natriuretic Peptide in Patients Hospitalized With Heart Failure With Preserved Ejection Fraction.
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DOI：
10.1161/jaha.119.015738
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发表时间：
2020-08-04
影响因子：
5.4
通讯作者：
Sharma K
中科院分区：
文献类型：
--
作者：
Vaishnav J;Chasler JE;Lee YJ;Ndumele CE;Hu JR;Schulman SP;Russell SD;Sharma K
保留射血分数（HFpEF）的心力衰竭占住院心力衰竭病例的一半，通常与肥胖有关。然而，利钠肽水平在住院肥胖伴HFpEF患者中的作用尚不明确。我们试图评估因急性心力衰竭住院的HFpEF患者的NT - proBNP （N -末端前B型利钠肽）水平随肥胖类别和相关临床结果的变化。89例HFpEF急性失代偿性心力衰竭住院患者被分为3类肥胖：非肥胖（体重指数[BMI] <30.0 kg/m2, 19%）、肥胖（体重指数[BMI] 30.0 - 39.9 kg/m2, 29%）和严重肥胖（体重指数≥40.0 kg/m2, 52%），并比较住院期间NT‐proBNP的百分比变化和临床结局。比较NT‐proBNP正常（≤125 pg/mL）和NT‐proBNP升高患者的临床特征。入院NT‐proBNP与BMI类别呈负相关（非肥胖，2607 pg/mL[四分位数范围，IQR: 2112-5703]；肥胖，1725 pg/mL [IQR: 889-3900]；严重肥胖，770.5 pg/mL [IQR: 128-1268]； P<0.01）。严重肥胖患者伴有利尿的NT‐proBNP变化百分比最大（- 64.8% [95% CI, - 85.4至- 38.9]，肥胖患者为- 40.4% [95% CI, - 74.3至- 12.0]，非肥胖患者为- 46.9% [95% CI, - 57.8至- 37.4]，P=0.03）。与严重肥胖患者相比，非肥胖患者和肥胖患者的1年生存率明显较差（分别为63%、76%和95%；P<0.01）。NT‐proBNP正常的患者（13%）比NT‐proBNP升高的患者更年轻，BMI更高，房颤更少，结构性心脏病更少。在HFpEF住院患者中，NT‐proBNP与BMI呈负相关，在肥胖程度最高的患者中NT‐proBNP下降幅度最大。这些发现对NT‐proBNP在肥胖HFpEF患者的诊断和治疗反应评估中的作用具有重要意义。
Heart failure with preserved ejection fraction (HFpEF) constitutes half of hospitalized heart failure cases and is commonly associated with obesity. The role of natriuretic peptide levels in hospitalized obese patients with HFpEF, however, is not well defined. We sought to evaluate change in NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) levels by obesity category and related clinical outcomes in patients with HFpEF hospitalized for acute heart failure. A total of 89 patients with HFpEF hospitalized with acute decompensated heart failure were stratified into 3 obesity categories: nonobese (body mass index [BMI] <30.0 kg/m2, 19%), obese (BMI 30.0–39.9 kg/m2, 29%), and severely obese (BMI ≥40.0 kg/m2, 52%), and compared for percent change in NT‐proBNP during hospitalization and clinical outcomes. Clinical characteristics were compared between patients with normal NT‐proBNP (≤125 pg/mL) and elevated NT‐proBNP. Admission NT‐proBNP was inversely related to BMI category (nonobese, 2607 pg/mL [interquartile range, IQR: 2112–5703]; obese, 1725 pg/mL [IQR: 889–3900]; and severely obese, 770.5 pg/mL [IQR: 128–1268]; P<0.01). Severely obese patients had the largest percent change in NT‐proBNP with diuresis (−64.8% [95% CI, −85.4 to −38.9] versus obese −40.4% [95% CI, −74.3 to −12.0] versus nonobese −46.9% [95% CI, −57.8 to −37.4]; P=0.03). Nonobese and obese patients had significantly worse 1‐year survival compared with severely obese patients (63% versus 76% versus 95%, respectively; P<0.01). Patients with normal NT‐proBNP (13%) were younger, with higher BMI, less atrial fibrillation, and less structural heart disease than those with elevated NT‐proBNP. In hospitalized patients with HFpEF, NT‐proBNP was inversely related to BMI with the largest decrease in NT‐proBNP seen in the highest obesity category. These findings have implications for the role of NT‐proBNP in the diagnosis and assessment of treatment response in obese patients with HFpEF.