McCord James, Mundy Brian J, Hudson Michael P, Maisel Alan S, Hollander Judd E, Abraham William T, Steg Philip G, Omland Torbjørn, Knudsen Cathrine W, Sandberg Keisha R, McCullough Peter A
Henry Ford Heart and Vascular Institute, Henry Ford Health System, Detroit, Mich., USA.
Arch Intern Med. 2004 Nov 8;164(20):2247-52. doi: 10.1001/archinte.164.20.2247.
The relationships among B-type natriuretic peptide (BNP) levels, body mass index (BMI), and congestive heart failure (CHF) as an emergency diagnosis are unknown.
Of 1586 participants in the Breathing Not Properly Multinational Study who had acute dyspnea, 1369 (86.3%) had BNP values and self-reported height and weight. Two independent cardiologists masked to the BNP results adjudicated the final diagnosis.
Congestive heart failure was found in 46% of participants. Individuals with higher BMIs were younger and had more frequent edema on examination but were equally as likely to have CHF vs noncardiac sources of dyspnea. A nearly 3-fold difference was seen in mean +/- SD BNP values at the low and high extremes of the BMI groupings (516.7 +/- 505.9 vs 176.3 +/- 270.5 pg/mL, respectively; P< .001). The correlations between BMI and log BNP among those with and without CHF were r = -0.34 and r = -0.21, respectively (P< .001 for both). Multivariate analysis for the outcome of log BNP among a small subset with CHF (n = 62) found that Framingham score (P = .002), estimated glomerular filtration rate (P = .007), female sex (P = .03), New York Heart Association functional class (P = .09), and third heart sound (P = .08) were independent predictors. However, BMI was not found to be independently related to log BNP (P = .59).
In patients with and without CHF, BNP levels are inversely related to BMI. When considering demographics, severity of disease, and renal function, BMI is not independently related to BNP levels in a small subgroup when detailed information about CHF severity is known.
B型利钠肽（BNP）水平、体重指数（BMI）与作为急诊诊断的充血性心力衰竭（CHF）之间的关系尚不清楚。
在“呼吸不畅”多国研究的1586名急性呼吸困难参与者中，1369人（86.3%）有BNP值以及自我报告的身高和体重。两名对BNP结果不知情的独立心脏病专家判定最终诊断。
46%的参与者被发现患有充血性心力衰竭。BMI较高的个体更年轻，检查时水肿更常见，但与非心源呼吸困难者相比，患CHF的可能性相同。在BMI分组的高低两端，平均±标准差BNP值存在近3倍差异（分别为516.7±505.9与176.3±270.5 pg/mL；P<0.001）。CHF患者和非CHF患者中，BMI与log BNP的相关性分别为r = -0.34和r = -0.21（两者P均<0.001）。对一小部分CHF患者（n = 62）的log BNP结果进行多变量分析发现，弗明汉评分（P = 0.002）、估计肾小球滤过率（P = 0.007）、女性（P = 0.03）、纽约心脏协会功能分级（P = 0.09）和第三心音（P = 0.08）是独立预测因素。然而，未发现BMI与log BNP独立相关（P = 0.59）。
无论有无CHF，BNP水平均与BMI呈负相关。当考虑人口统计学、疾病严重程度和肾功能时，在一小部分已知CHF严重程度详细信息的亚组中，BMI与BNP水平无独立相关性。
