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NT-proBNP for Risk Prediction in Heart Failure: Identification of Optimal Cutoffs Across Body Mass Index Categories
Giuseppe Vergaro1, Francesco Gentile2, Laura M G Meems3
1Scuola Superiore Sant'Anna, Pisa, Italy; Fondazione Toscana G. Monasterio, Pisa, Italy.
JACC. Heart Failure
|July 11, 2021
Summary
N-terminal pro-B-type natriuretic peptide (NT-proBNP) predicts heart failure outcomes. Optimal NT-proBNP cutoffs for risk prediction decrease with increasing body mass index (BMI), especially in overweight and obese individuals.
Area of Science:
- Cardiology
- Biomarkers in Heart Failure
- Obesity and Cardiovascular Health
Background:
- N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a known predictor of outcomes in heart failure (HF).
- While lower NT-proBNP levels are associated with higher body mass index (BMI), the impact of obesity on the prognostic value of NT-proBNP in HF remains unclear.
Purpose of the Study:
- To evaluate the predictive capability of NT-proBNP and its optimal decision cutoffs for heart failure prognosis across various body mass index (BMI) categories.
Main Methods:
- Analysis of individual patient data from the Biomarkers In Heart Failure Outpatient Study (BIOS) consortium.
- Classification of stable heart failure patients into underweight, normal weight, overweight, and multiple categories of obesity based on BMI.
- Assessment of the prognostic role of NT-proBNP for all-cause and cardiac death endpoints.
Main Results:
- NT-proBNP levels showed an inverse correlation with BMI.
- The addition of NT-proBNP to clinical models improved risk prediction for heart failure outcomes across most BMI categories, except for severely obese patients.
- Optimal NT-proBNP cutoffs for predicting 5-year all-cause mortality decreased progressively with increasing BMI and were higher in women than in men.
Conclusions:
- NT-proBNP retains its independent prognostic value in heart failure patients with BMI up to 40 kg/m².
- Lower optimal risk-prediction cutoffs for NT-proBNP are identified in overweight and obese heart failure patients.
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