• Ankeet S Bhatt, Lauren B Cooper, Andrew P Ambrosy, Robert M Clare, Adrian Coles, Emer Joyce, Arun Krishnamoorthy, Javed Butler, G Michael Felker, Justin A Ezekowitz, Paul W Armstrong, Adrian F Hernandez, Christopher M O'Connor, and Robert J Mentz.
• Department of Medicine, Duke University Medical Center, Durham, NC.
• J Am Heart Assoc. 2018 Feb 3; 7 (3).

BackgroundHigher body mass index (BMI) is associated with lower circulating levels of N-terminal-pro-b-type natriuretic peptide (NT-proBNP). The Interaction between BMI and NT-proBNP with respect to clinical outcomes is not well characterized in patients with acute heart failure.Methods And ResultsA total of 686 patients from the biomarker substudy of the ASCEND-HF (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated HF ) clinical trial with documented NT-proBNP levels at baseline were included in the present analysis. Patients were classified by the World Health Organization obesity classification (nonobese: BMI <30 kg/m2, Class I obesity: BMI 30-34.9 kg/m2, Class II obesity BMI 35-39.9 kg/m2, and Class III obesity BMI ≥40 kg/m2). We assessed baseline characteristics and 30- and 180-day outcomes by BMI class and explored the interaction between BMI and NT-proBNP for these outcomes. Study participants had a median age of 67 years (55, 78) and 71% were female. NT-proBNP levels were inversely correlated with BMI (P<0.001). Higher NT-proBNP levels were associated with higher 180-day mortality (adjusted hazard ratio for each doubling of NT-proBNP, 1.40; 95% confidence interval, 1.16, 1.71; P<0.001), but not 30-day outcomes. The effect of NT-proBNP on 180-day death was not modified by BMI class (interaction P=0.24).ConclusionsThe prognostic value of NT-proBNP was not modified by BMI in this acute heart failure population. NT-proBNP remains a useful prognostic indicator of long-term mortality in acute heart failure even in the obese patient.Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT00475852.© 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

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