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      Highest Obesity Category Associated With Largest Decrease in N‐Terminal Pro‐B‐Type Natriuretic Peptide in Patients Hospitalized With Heart Failure With Preserved Ejection Fraction

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          Abstract

          Background

          Heart failure with preserved ejection fraction ( HFp EF) constitutes half of hospitalized heart failure cases and is commonly associated with obesity. The role of natriuretic peptide levels in hospitalized obese patients with HFp EF, however, is not well defined. We sought to evaluate change in NT‐pro BNP (N‐terminal pro‐B‐type natriuretic peptide) levels by obesity category and related clinical outcomes in patients with HFp EF hospitalized for acute heart failure.

          Methods and Results

          A total of 89 patients with HFp EF hospitalized with acute decompensated heart failure were stratified into 3 obesity categories: nonobese ( body mass index [BMI] <30.0 kg/m 2, 19%), obese ( BMI 30.0–39.9 kg/m 2, 29%), and severely obese ( BMI ≥40.0 kg/m 2, 52%), and compared for percent change in NT‐pro BNP during hospitalization and clinical outcomes. Clinical characteristics were compared between patients with normal NT‐pro BNP (≤125 pg/ mL) and elevated NT‐pro BNP. Admission NT‐pro BNP 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]; P<0.01). Severely obese patients had the largest percent change in NT‐pro BNP 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]; P=0.03). Nonobese and obese patients had significantly worse 1‐year survival compared with severely obese patients (63% versus 76% versus 95%, respectively; P<0.01). Patients with normal NT‐pro BNP (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 HFp EF, NT‐pro BNP was inversely related to BMI with the largest decrease in NT‐pro BNP seen in the highest obesity category. These findings have implications for the role of NT‐pro BNP in the diagnosis and assessment of treatment response in obese patients with HFp EF.

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          Most cited references30

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          A new equation to estimate glomerular filtration rate.

          Equations to estimate glomerular filtration rate (GFR) are routinely used to assess kidney function. Current equations have limited precision and systematically underestimate measured GFR at higher values. To develop a new estimating equation for GFR: the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Cross-sectional analysis with separate pooled data sets for equation development and validation and a representative sample of the U.S. population for prevalence estimates. Research studies and clinical populations ("studies") with measured GFR and NHANES (National Health and Nutrition Examination Survey), 1999 to 2006. 8254 participants in 10 studies (equation development data set) and 3896 participants in 16 studies (validation data set). Prevalence estimates were based on 16,032 participants in NHANES. GFR, measured as the clearance of exogenous filtration markers (iothalamate in the development data set; iothalamate and other markers in the validation data set), and linear regression to estimate the logarithm of measured GFR from standardized creatinine levels, sex, race, and age. In the validation data set, the CKD-EPI equation performed better than the Modification of Diet in Renal Disease Study equation, especially at higher GFR (P < 0.001 for all subsequent comparisons), with less bias (median difference between measured and estimated GFR, 2.5 vs. 5.5 mL/min per 1.73 m(2)), improved precision (interquartile range [IQR] of the differences, 16.6 vs. 18.3 mL/min per 1.73 m(2)), and greater accuracy (percentage of estimated GFR within 30% of measured GFR, 84.1% vs. 80.6%). In NHANES, the median estimated GFR was 94.5 mL/min per 1.73 m(2) (IQR, 79.7 to 108.1) vs. 85.0 (IQR, 72.9 to 98.5) mL/min per 1.73 m(2), and the prevalence of chronic kidney disease was 11.5% (95% CI, 10.6% to 12.4%) versus 13.1% (CI, 12.1% to 14.0%). The sample contained a limited number of elderly people and racial and ethnic minorities with measured GFR. The CKD-EPI creatinine equation is more accurate than the Modification of Diet in Renal Disease Study equation and could replace it for routine clinical use. National Institute of Diabetes and Digestive and Kidney Diseases.
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            2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America

            Circulation, 136(6)
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              Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure.

              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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                Author and article information

                Contributors
                ksharma8@jhmi.edu
                Journal
                J Am Heart Assoc
                J Am Heart Assoc
                10.1002/(ISSN)2047-9980
                JAH3
                ahaoa
                Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
                John Wiley and Sons Inc. (Hoboken )
                2047-9980
                30 July 2020
                04 August 2020
                : 9
                : 15 ( doiID: 10.1002/jah3.v9.15 )
                : e015738
                Affiliations
                [ 1 ] Department of Medicine Division of Cardiology Johns Hopkins University School of Medicine Baltimore MD
                [ 2 ] Bloomberg School of Public Health Johns Hopkins University Baltimore MD
                [ 3 ] Department of Medicine Division of Cardiology Duke University Durham NC
                Author notes
                [*] [* ]Correspondence to: Kavita Sharma, MD, Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Carnegie 568B Baltimore, MD 21287. E‐mail: ksharma8@ 123456jhmi.edu .
                Author information
                https://orcid.org/0000-0002-3012-1765
                Article
                JAH35273
                10.1161/JAHA.119.015738
                7792252
                32750299
                a664d18e-b64c-4405-892d-3a997f879a2e
                © 2020 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ 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
                Page count
                Figures: 2, Tables: 4, Pages: 11, Words: 7336
                Funding
                Funded by: American Heart Association Go Red for Women Network
                Award ID: AHA #16SFRN28780016
                Funded by: Johns Hopkins University , open-funder-registry 10.13039/100007880;
                Categories
                Original Research
                Original Research
                Heart Failure
                Custom metadata
                2.0
                04 August 2020
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.9.3 mode:remove_FC converted:10.11.2020

                Cardiovascular Medicine
                diuresis,heart failure with preserved ejection fraction,natriuretic peptides,nt‐probnp,obesity,heart failure,metabolic syndrome,biomarkers

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