How obesity affects the cut-points for B-type natriuretic peptide in the diagnosis of acute heart failure: Results from the Breathing Not Properly Multinational Study
How obesity affects the cut-points for B-type natriuretic peptide in the diagnosis of acute heart failure: Results from the Breathing Not Properly Multinational Study
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DOI：
10.1016/j.ahj.2005.10.011
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发表时间：
2006-05-01
影响因子：
4.8
通讯作者：
Maisel, Alan S.
中科院分区：
文献类型：
--
作者：
Daniels, Lori B.;Clopton, Paul;Maisel, Alan S.
背景b型利钠肽（BNP）在诊断心力衰竭（HF）方面有价值，但其在肥胖患者中的应用尚不清楚。研究提示，诊断HF的临界值为BNP >= 100 pg/mL；然而，BNP水平与体重指数呈反比关系。我们评估了不同身体质量指数水平的BNP诊断急性HF的不同临界值，以确定替代临界值是否可以改善诊断。方法呼吸不正常多国研究是一项7个中心的前瞻性研究，对1586例因急性呼吸困难就诊于急诊科的患者进行了研究。到达时测定b型利钠肽。1368名参与者的身高和体重数据可用。心衰的临床诊断是由2名独立的心脏病专家判定的，他们对BNP结果不知情。结果46.1%的患者最终诊断为心力衰竭。精瘦、超重/肥胖和严重/病态肥胖患者的平均BNP水平（pg/mL）在急性心衰患者中分别为643,462和247，在非心衰患者中分别为52,35和25（除35 vs 25外，所有比较均P < 0.05）。保持90% HF诊断敏感性的b型利钠肽切点为：瘦人170 pg/mL，超重/肥胖110 pg/mL，重度/病态肥胖54 pg/mL。结论体重指数影响急性心衰诊断BNP分界点的选择。严重肥胖患者应采用较低的临界值（BNP >= 54 pg/mL）以保持敏感性。瘦弱患者中更高的临界值（BNP >= 170 pg/mL）可用于提高特异性。
Background B-type natriuretic peptide (BNP) is valuable in diagnosing heart failure (HF), but its utility in obese patients is unknown. Studies have suggested a cut-point of BNP >= 100 pg/mL for the diagnosis of HF; however, there is an inverse relation between BNP levels and body mass index. We evaluated differential cut-points for BNP in diagnosing acute HF across body mass index levels to determine whether alternative cut-points can improve diagnosis.Methods The Breathing Not Properly Multinational Study was a 7-center, prospective study of 1586 patients who presented to the Emergency Department with acute dyspnea. B-type natriuretic peptide was measured on arrival. Height and weight data were available for 1368 participants. The clinical diagnosis of HF was adjudicated by 2 independent cardiologists who were blinded to BNP results.Results Heart failure was the final diagnosis in 46.1%. Mean BNP levels (pg/mL) in lean, overweight/obese, and severely/morbidly obese patients were 643, 462, and 247 for patients with acute HF, and 52, 35, and 25 in those without HF, respectively (P < .05 for all comparisons except 35 vs 25). B-type natriuretic peptide cut-points to maintain 90% sensitivity for a HF diagnosis were 170 pg/mL for lean subjects, 110 pg/mL for overweight/obese subjects, and 54 pg/mL in severely/morbidly obese patients.Conclusions Body mass index influences the selection of cut-points for BNP in diagnosing acute HF. A lower cut-point (BNP >= 54 pg/mL) should be used in severely obese patients to preserve sensitivity. A higher cut-point in lean patients (BNP >= 170 pg/mL) could be used to increase specificity.