Department of Medicine Division of Cardiology Johns Hopkins University School of Medicine Baltimore MD.
Bloomberg School of Public Health Johns Hopkins University Baltimore MD.
J Am Heart Assoc. 2020 Aug 4;9(15):e015738. doi: 10.1161/JAHA.119.015738. Epub 2020 Jul 30.
Background 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. Methods and Results 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/m, 19%), obese (BMI 30.0-39.9 kg/m, 29%), and severely obese (BMI ≥40.0 kg/m, 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]; <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]; =0.03). Nonobese and obese patients had significantly worse 1-year survival compared with severely obese patients (63% versus 76% versus 95%, respectively; <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. Conclusions 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.
射血分数保留型心力衰竭（HFpEF）占住院心力衰竭病例的一半，通常与肥胖有关。然而，在因急性心力衰竭住院的肥胖 HFpEF 患者中，利钠肽水平的作用尚不清楚。我们旨在评估肥胖类别对 NT-proBNP（氨基末端 B 型利钠肽前体）水平的影响，并评估其与 HFpEF 患者急性失代偿性心力衰竭住院期间相关临床结局的关系。
共纳入 89 例因急性失代偿性心力衰竭住院的 HFpEF 患者，根据肥胖程度分为 3 组：非肥胖组（BMI<30.0 kg/m²，占 19%）、肥胖组（BMI 30.0-39.9 kg/m²，占 29%）和重度肥胖组（BMI≥40.0 kg/m²，占 52%），比较住院期间 NT-proBNP 的变化百分比和临床结局。比较 NT-proBNP 正常（≤125 pg/mL）和升高（>125 pg/mL）患者的临床特征。入院时 NT-proBNP 与 BMI 类别呈负相关（非肥胖组为 2607 pg/mL [四分位距：2112-5703]；肥胖组为 1725 pg/mL [四分位距：889-3900]；重度肥胖组为 770.5 pg/mL [四分位距：128-1268]；<0.01）。与肥胖组（-40.4% [95%CI，-74.3 至-12.0]）和非肥胖组（-46.9% [95%CI，-57.8 至-37.4]）相比，重度肥胖组 NT-proBNP 的利尿后降幅最大（-64.8% [95%CI，-85.4 至-38.9]；=0.03）。与重度肥胖组相比，非肥胖组和肥胖组患者 1 年生存率明显更差（分别为 63%、76%和 95%；<0.01）。NT-proBNP 正常（13%）患者比 NT-proBNP 升高（>125 pg/mL）患者更年轻，BMI 更高，心房颤动更少，结构性心脏病更少。
在因 HFpEF 住院的患者中，NT-proBNP 与 BMI 呈负相关，肥胖程度最高的患者 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启示意义。
