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)

Ankeet S Bhatt, Lauren B Cooper, Andrew P Ambrosy, Robert M Clare, Adrian Coles, Emer Joyce, Arun Krishnamoorthy, Javed Butler, G Michael Felker, Justin A Ezekowitz, Paul W Armstrong, Adrian F Hernandez, Christopher M O'Connor, Robert J Mentz, Ankeet S Bhatt, Lauren B Cooper, Andrew P Ambrosy, Robert M Clare, Adrian Coles, Emer Joyce, Arun Krishnamoorthy, Javed Butler, G Michael Felker, Justin A Ezekowitz, Paul W Armstrong, Adrian F Hernandez, Christopher M O'Connor, Robert J Mentz

Abstract

Background: Higher body mass index (BMI) is associated with lower circulating levels of N-terminal-pro-b-type natriuretic peptide (NT-proBNP). The Interaction between BMI and NT-proBNP 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-proBNP levels at baseline were included in the present analysis. Patients were classified by the World Health Organization obesity classification (nonobese: BMI <30 kg/m2, Class I obesity: BMI 30-34.9 kg/m2, Class II obesity BMI 35-39.9 kg/m2, and Class III obesity BMI ≥40 kg/m2). We assessed baseline characteristics and 30- and 180-day outcomes by BMI class and explored the interaction between BMI and NT-proBNP for these outcomes. Study participants had a median age of 67 years (55, 78) and 71% were female. NT-proBNP levels were inversely correlated with BMI (P<0.001). Higher NT-proBNP levels were associated with higher 180-day mortality (adjusted hazard ratio for each doubling of NT-proBNP, 1.40; 95% confidence interval, 1.16, 1.71; P<0.001), but not 30-day outcomes. The effect of NT-proBNP on 180-day death was not modified by BMI class (interaction P=0.24).

Conclusions: The prognostic value of NT-proBNP was not modified by BMI in this acute heart failure population. NT-proBNP 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.

Keywords: N‐terminal‐pro‐b‐type natriuretic peptide; Obesity; acute heart failure; body mass index.

© 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Figures

Figure 1
Figure 1
Baseline NT‐proBNP by BMI class. Values of NT‐proBNP >50 000 (n=12) are excluded from plot area. Line represents median, box represents interquartile range (IQR), upper bar represents 75% percentile+1.5 (IQR), lower bar represents 25% percentile—1.5 (IQR), and dots represent outliers included in this analysis. BMI indicates body mass index; NT‐proBNP, N‐terminal‐pro‐b‐type natriuretic peptide.
Figure 2
Figure 2
Percent change in NT‐proBNP at 48/72 hours by BMI class. Line represents median, box represents interquartile range (IQR), upper bar represents 75% percentile+1.5 (IQR), lower bar represents 25% percentile—1.5 (IQR), and dots represent outliers included in this analysis. BMI indicates body mass index; NT‐proBNP, N‐terminal‐pro‐b‐type natriuretic peptide.

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