TY - JOUR
T1 - Diagnostic and prognostic considerations for use of natriuretic peptides in obese patients with heart failure
AU - Singh, Shruti
AU - Pandey, Ambarish
AU - Neeland, Ian J
N1 - Funding Information:
This work was supported by the National Institute for Diabetes Digestive and Kidney Diseases (NIDDK) , Grant to Dr. Neeland, K23 DK106520
Funding Information:
Dr. Neeland has received consulting fees from Boehringer Ingelheim/Lilly Alliance, AMRA Medical, and Merck; and a research grant from Novo Nordisk. All other authors have no relevant disclosures to report.
Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2020/9/1
Y1 - 2020/9/1
N2 - Natriuretic peptides (NPs, B-type natriuretic peptide /BNP and NT-proBNP) are universally used biomarkers with established cut-points to aid in the diagnosis of heart failure (HF). It has been demonstrated that an inverse relationship exists between obesity, defined by the body mass index (BMI), and NPs, such that the application of NPs to diagnostic algorithms in HF remains challenging in overweight and obese patients. Some have advocated that lowering the cut-offs for NPs or using a correction for high BMI may improve the diagnostic accuracy in obese individuals. The inverse relationship of NPs with high BMI is present in both HF with reduced (HFrEF) and with preserved (HFpEF) ejection fraction, although levels tend to be higher in HFrEF. Nevertheless, data from several studies have shown that the prognostic value of NPs is preserved across BMI classes, and that increasing circulating levels of NPs correlate with adverse outcomes including all-cause mortality and HF hospitalizations. While NPs can still be used in diagnosis of HF in obese individuals, lower thresholds and the clinical context should be utilized in decision making. Additionally, given the validated prognostic value even in obesity, NPs can be employed in risk-stratification of individuals with obesity and HF, although there remains limited evidence about use in those with severe obesity (BMI >40 kg/m2).
AB - Natriuretic peptides (NPs, B-type natriuretic peptide /BNP and NT-proBNP) are universally used biomarkers with established cut-points to aid in the diagnosis of heart failure (HF). It has been demonstrated that an inverse relationship exists between obesity, defined by the body mass index (BMI), and NPs, such that the application of NPs to diagnostic algorithms in HF remains challenging in overweight and obese patients. Some have advocated that lowering the cut-offs for NPs or using a correction for high BMI may improve the diagnostic accuracy in obese individuals. The inverse relationship of NPs with high BMI is present in both HF with reduced (HFrEF) and with preserved (HFpEF) ejection fraction, although levels tend to be higher in HFrEF. Nevertheless, data from several studies have shown that the prognostic value of NPs is preserved across BMI classes, and that increasing circulating levels of NPs correlate with adverse outcomes including all-cause mortality and HF hospitalizations. While NPs can still be used in diagnosis of HF in obese individuals, lower thresholds and the clinical context should be utilized in decision making. Additionally, given the validated prognostic value even in obesity, NPs can be employed in risk-stratification of individuals with obesity and HF, although there remains limited evidence about use in those with severe obesity (BMI >40 kg/m2).
KW - B-type natriuretic peptide
KW - Heart failure
KW - Natriuretic peptides
KW - Obesity
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U2 - 10.1016/j.pcad.2020.09.006
DO - 10.1016/j.pcad.2020.09.006
M3 - Review article
C2 - 33002457
AN - SCOPUS:85092148699
SN - 0033-0620
VL - 63
SP - 649
EP - 655
JO - Progress in Cardiovascular Diseases
JF - Progress in Cardiovascular Diseases
IS - 5
ER -