Interaction of Body Mass Index on the Association Between N‐Terminal‐Pro‐b‐Type Natriuretic Peptide and Morbidity and Mortality in Patients With Acute Heart Failure: Findings From ASCEND‐HF (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure)

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Abstract

Background

Higher body mass index ( BMI) is associated with lower circulating levels of N‐terminal‐pro‐b‐type natriuretic peptide ( NT‐pro BNP). The Interaction between BMI and NT‐pro BNP with respect to clinical outcomes is not well characterized in patients with acute heart failure.

Methods and Results

A 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‐pro BNP levels at baseline were included in the present analysis. Patients were classified by the World Health Organization obesity classification (nonobese: BMI <30 kg/m ², Class I obesity: BMI 30–34.9 kg/m ², Class II obesity BMI 35–39.9 kg/m ², and Class III obesity BMI ≥40 kg/m ²). We assessed baseline characteristics and 30‐ and 180‐day outcomes by BMI class and explored the interaction between BMI and NT‐pro BNP for these outcomes. Study participants had a median age of 67 years (55, 78) and 71% were female. NT‐pro BNP levels were inversely correlated with BMI ( P<0.001). Higher NT‐pro BNP levels were associated with higher 180‐day mortality (adjusted hazard ratio for each doubling of NT‐pro BNP, 1.40; 95% confidence interval, 1.16, 1.71; P<0.001), but not 30‐day outcomes. The effect of NT‐pro BNP on 180‐day death was not modified by BMI class (interaction P=0.24).

Conclusions

The prognostic value of NT‐pro BNP was not modified by BMI in this acute heart failure population. NT‐pro BNP remains a useful prognostic indicator of long‐term mortality in acute heart failure even in the obese patient.

Clinical Trial Registration

URL: http://www.clinicaltrials.gov. Unique identifier: NCT00475852.

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Most cited references 27

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Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure.

Alan Maisel, Padma Krishnaswamy, Richard M. Nowak … (2002)

B-type natriuretic peptide is released from the cardiac ventricles in response to increased wall tension. We conducted a prospective study of 1586 patients who came to the emergency department with acute dyspnea and whose B-type natriuretic peptide was measured with a bedside assay. The clinical diagnosis of congestive heart failure was adjudicated by two independent cardiologists, who were blinded to the results of the B-type natriuretic peptide assay. The final diagnosis was dyspnea due to congestive heart failure in 744 patients (47 percent), dyspnea due to noncardiac causes in 72 patients with a history of left ventricular dysfunction (5 percent), and no finding of congestive heart failure in 770 patients (49 percent). B-type natriuretic peptide levels by themselves were more accurate than any historical or physical findings or laboratory values in identifying congestive heart failure as the cause of dyspnea. The diagnostic accuracy of B-type natriuretic peptide at a cutoff of 100 pg per milliliter was 83.4 percent. The negative predictive value of B-type natriuretic peptide at levels of less than 50 pg per milliliter was 96 percent. In multiple logistic-regression analysis, measurements of B-type natriuretic peptide added significant independent predictive power to other clinical variables in models predicting which patients had congestive heart failure. Used in conjunction with other clinical information, rapid measurement of B-type natriuretic peptide is useful in establishing or excluding the diagnosis of congestive heart failure in patients with acute dyspnea. Copyright 2002 Massachusetts Medical Society.

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Effect of nesiritide in patients with acute decompensated heart failure.

C M O'Connor, R C Starling, A. F Hernández … (2011)

Nesiritide is approved in the United States for early relief of dyspnea in patients with acute heart failure. Previous meta-analyses have raised questions regarding renal toxicity and the mortality associated with this agent. We randomly assigned 7141 patients who were hospitalized with acute heart failure to receive either nesiritide or placebo for 24 to 168 hours in addition to standard care. Coprimary end points were the change in dyspnea at 6 and 24 hours, as measured on a 7-point Likert scale, and the composite end point of rehospitalization for heart failure or death within 30 days. Patients randomly assigned to nesiritide, as compared with those assigned to placebo, more frequently reported markedly or moderately improved dyspnea at 6 hours (44.5% vs. 42.1%, P=0.03) and 24 hours (68.2% vs. 66.1%, P=0.007), but the prespecified level for significance (P≤0.005 for both assessments or P≤0.0025 for either) was not met. The rate of rehospitalization for heart failure or death from any cause within 30 days was 9.4% in the nesiritide group versus 10.1% in the placebo group (absolute difference, -0.7 percentage points; 95% confidence interval [CI], -2.1 to 0.7; P=0.31). There were no significant differences in rates of death from any cause at 30 days (3.6% with nesiritide vs. 4.0% with placebo; absolute difference, -0.4 percentage points; 95% CI, -1.3 to 0.5) or rates of worsening renal function, defined by more than a 25% decrease in the estimated glomerular filtration rate (31.4% vs. 29.5%; odds ratio, 1.09; 95% CI, 0.98 to 1.21; P=0.11). Nesiritide was not associated with an increase or a decrease in the rate of death and rehospitalization and had a small, nonsignificant effect on dyspnea when used in combination with other therapies. It was not associated with a worsening of renal function, but it was associated with an increase in rates of hypotension. On the basis of these results, nesiritide cannot be recommended for routine use in the broad population of patients with acute heart failure. (Funded by Scios; ClinicalTrials.gov number, NCT00475852.).

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NT-proBNP testing for diagnosis and short-term prognosis in acute destabilized heart failure: an international pooled analysis of 1256 patients: the International Collaborative of NT-proBNP Study.

James Januzzi, Roland van Kimmenade, John G Lainchbury … (2006)

Experience with amino-terminal pro-brain natriuretic peptide (NT-proBNP) testing for evaluation of dyspnoeic patients with suspected acute heart failure (HF) is limited to single-centre studies. We wished to establish broader standards for NT-proBNP testing in a study involving four sites in three continents. Differences in NT-proBNP levels among 1256 patients with and without acute HF and the relationship between NT-proBNP levels and HF symptoms were examined. Optimal cut-points for diagnosis and prognosis were identified and verified using bootstrapping and multi-variable logistic regression techniques. Seven hundred and twenty subjects (57.3%) had acute HF, whose median NT-proBNP was considerably higher than those without (4639 vs. 108 pg/mL, P 75, which yielded 90% sensitivity and 84% specificity for acute HF. An age-independent cut-point of 300 pg/mL had 98% negative predictive value to exclude acute HF. Among those with acute HF, a presenting NT-proBNP concentration >5180 pg/mL was strongly predictive of death by 76 days [odds ratio=5.2, 95% confidence interval (CI)=2.2-8.1, P<0.001]. In this multi-centre, international study, NT-proBNP testing was valuable for diagnostic evaluation and short-term prognosis estimation in dyspnoeic subjects with suspected or confirmed acute HF and should establish broader standards for use of the NT-proBNP in dyspnoeic patients.

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Author and article information

Contributors

Robert J. Mentz: robert.mentz@duke.edu

Journal

Journal ID (nlm-ta): J Am Heart Assoc

Journal ID (iso-abbrev): J Am Heart Assoc

Journal ID (doi): 10.1002/(ISSN)2047-9980

Journal ID (publisher-id): JAH3

Journal ID (hwp): ahaoa

Title: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease

Publisher: John Wiley and Sons Inc. (Hoboken )

ISSN (Electronic): 2047-9980

Publication date (Electronic): 03 February 2018

Publication date Collection: February 2018

Volume: 7

Issue: 3 ( doiID: 10.1002/jah3.2018.7.issue-3 )

Electronic Location Identifier: e006740

Affiliations

[ ¹ ] Department of Medicine Duke University Medical Center Durham NC

[ ² ] Inova Heart & Vascular Institute Falls Church VA

[ ³ ] Duke Clinical Research Institute Durham NC

[ ⁴ ] Department of Cardiovascular Medicine Cleveland Clinic Foundation Cleveland OH

[ ⁵ ] Piedmont Heart Institute Atlanta GA

[ ⁶ ] Stony Brook Heart Institute Stony Brook NY

[ ⁷ ] Division of Cardiology University of Alberta Edmonton Alberta Canada

Author notes

[*] [* ] Correspondence to: Robert J. Mentz, MD, Duke Clinical Research Institute, P.O. Box 17969, Durham, NC 27715. E‐mail: robert.mentz@ 123456duke.edu

Article

Publisher ID: JAH32895

DOI: 10.1161/JAHA.117.006740

PMC ID: 5850232

PubMed ID: 29431103

SO-VID: 01c5646d-a6bf-4fdc-b92a-cd8e1fd819dd

License:

This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

History

Date received : 10 July 2017

Date accepted : 04 December 2017

Page count

Figures: 2, Tables: 5, Pages: 10, Words: 8508

Funding

Funded by: Johnson & Johnson

Funded by: Duke Clinical Research Institute

Custom metadata

source-schema-version-number 2.0

component-id jah32895

cover-date February 2018

details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_NLMPMC version:version=5.3.2.2 mode:remove_FC converted:06.02.2018

ScienceOpen disciplines: Cardiovascular Medicine

Keywords: acute heart failure,body mass index,n‐terminal‐pro‐b‐type natriuretic peptide,obesity,biomarkers,heart failure

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ScienceOpen disciplines: Cardiovascular Medicine

Keywords: acute heart failure, body mass index, n‐terminal‐pro‐b‐type natriuretic peptide, obesity, biomarkers, heart failure

Interaction of Body Mass Index on the Association Between N‐Terminal‐Pro‐b‐Type Natriuretic Peptide and Morbidity and Mortality in Patients With Acute Heart Failure: Findings From ASCEND‐HF (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure)

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Abstract

Background

Methods and Results

Conclusions

Clinical Trial Registration

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Karger: Nutrition and Dietetics

Most cited references 27

Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure.

Effect of nesiritide in patients with acute decompensated heart failure.

NT-proBNP testing for diagnosis and short-term prognosis in acute destabilized heart failure: an international pooled analysis of 1256 patients: the International Collaborative of NT-proBNP Study.

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