Impact of Body Mass Index on the Accuracy of N-Terminal Pro-Brain Natriuretic Peptide and Brain Natriuretic Peptide for Predicting Outcomes in Patients With Chronic Heart Failure and Reduced Ejection Fraction: Insights From the PARADIGM-HF Study (Prospective Comparison of ARNI With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure Trial)

Nadruz W Jr, Claggett BL, McMurray JJ, et al.
Circulation. 2016;134:1785-1787.

Background

Obese HF patients have lower BNP and NT-proBNP levels compared with non-obese patients [1,2]. Therefore, it remains uncertain whether the BMI influences the prognostic value of natriuretic peptides (NP) in obese HF patients.
In this analysis, the impact of BMI on the predictive value of NT-proBNP and BNP was evaluated, in HFrEF patients from the PARADIGM-HF trial [3]. The primary endpoint was the composite of CV death or a first HF hospitalisation.

Main results

• The mean age was 64±11 years, 78% of patients were male, and the mean BMI was 28.0±5.6 kg/m². NP levels were inversely related to BMI (P for trend <0.001 for NT-proBNP and BNP).
• Patients were categorized into 4 groups according to BMI: <25.0 (non-overweight/obese); BMI 25.0 - 29.9 (overweight); BMI 30.0 - 34.9 (obese); and BMI ≥35.0 kg/m² (moderately/severely obese).
• During the follow-up period, (median: 27 months), NP levels were predictive of the primary outcome in all BMI categories, but the association was weaker in the highest BMI group (P for interaction=0.030 for NT-proBNP; P=0.058 for BNP).
• When added to clinical variables, the incremental value of NP levels was diminished in the highest BMI quartile.

Conclusion

In HFrEF patients from the PARADIGM-HF trial, higher baseline NP levels were consistently associated with CV death or HF hospitalisation in all BMI categories. These data support the opinion that NP levels are useful prognostic tools across the BMI spectrum. However, the ability of NTproBNP and BNP to predict prognosis was attenuated in the highest BMI category, suggesting a diminished prognostic ability of NP among moderately/severely obese patients.

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References

 1. Mehra MR, Uber PA, Park MH, et al. Obesity and suppressed B-type natriuretic peptide levels in heart failure. J Am Coll Cardiol. 2004;43:1590–1595.
2. Frankenstein L, Remppis A, Nelles M, et al. Relation of N-terminal pro-brain natriuretic peptide levels and their prognostic power in chronic stable heart failure to obesity status. Eur Heart J. 2008;29:2634–2640.
3. McMurray JJ, Packer M, Desai AS, et al; PARADIGM-HF Investigators and Committees. Angiotensinneprilysin inhibition versus enalapril in heart failure. N Engl J Med. 2014;371:993–1004.