Body Composition, Natriuretic Peptides, and Adverse Outcomes in Heart Failure With Preserved and Reduced Ejection Fraction

Selvaraj, Senthil; Kim, Jessica; Ansari, Bilal; Zhao, Lei; Cvijic, Mary Ellen; Fronheiser, Matthew P.; Vanjarapu, Jagan Mohan-Rao; Kumar, Anupam; Suri, Arpita; Yenigalla, Sowjanya; Satija, Vaibhav; Ans, Armghan H; Narvaez‐Guerra, Offdan; Herrera‐Enriquez, Karela; Obeid, Mary Jo; Lee, Jonathan J.; Jehangir, Qasim; Seiffert, Dietmar; Car, Bruce D.; Gordon, David; Chirinos, Julio A.

doi:10.1016/j.jcmg.2020.07.022

Cited by 42 publications

(37 citation statements)

References 28 publications

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“…Indeed, in a multivariable adjusted model, NT-proBNP levels were lower in women compared with men as BMI increased, whereas abdominal obesity was associated with lower NT-proBNP levels only among women (8). The role of body composition on natriuretic peptides has received recent interest, with higher NT-proBNP concentrations associated with a more favorable adiposity profile, marked by less visceral and hepatic fat and lower skeletal muscle mass (43,44). This supports the potential role of androgen concentrations between women and men as a potential mediator of this finding, as originally suggested by Chang et al (45).…”

Section: Discussionmentioning

confidence: 99%

NT-proBNP for Risk Prediction in Heart Failure

Vergaro

Gentile

Meems

et al. 2021

JACC: Heart Failure

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Section: Discussionmentioning

confidence: 99%

NT-proBNP for Risk Prediction in Heart Failure

Vergaro

Gentile

Meems

et al. 2021

JACC: Heart Failure

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“…The inverse relationship of BNP with increasing BMI was maintained in reduced and preserved EF, however, BNP levels were significantly higher in HFrEF patients when compared to HFpEF patients in each obesity class, except in the severely obese (BMI >40 kg/m 2 ). The authors of a recent study comparing HFpEF and HFrEF proposed that lower NP levels seen in HFpEF may be related to muscle mass rather than adiposity (31). The study demonstrated an inverse relationship between axial muscle mass and NTproBNP.…”

Section: Nps In Diagnosis Of Hf In Obese Individualsmentioning

confidence: 90%

Diagnostic and prognostic considerations for use of natriuretic peptides in obese patients with heart failure

Singh

Pandey

Neeland

2020

Progress in Cardiovascular Diseases

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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/m 2 ).

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“…Abdominal adipose deposition has a close relationship with systemic inflammation [ 5 ] and is also a prominent feature of HFpEF [ 6 , 7 ]. Several studies have demonstrated that abdominal obesity may predict adverse consequences and a greater risk of all-cause mortality in patients with HFpEF [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Waist to height ratio is associated with an increased risk of mortality in Chinese patients with heart failure with preserved ejection fraction

Chen

Hao

et al. 2021

BMC Cardiovasc Disord

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Background Abdominal obesity as a predominant comorbidity has played a key role in the incidence and worsening of heart failure with preserved ejection fraction (HFpEF), and waist-to-height ratio (WHtR) behaves better than waist circumference or body mass index in evaluating abdominal obesity. While the association between WHtR and all-cause death in Chinese patients with HFpEF remains unclear. Methods Patients with stable HFpEF (N = 2041) who presented to our hospital from January 2008 to July 2019 were divided into low-WHtR (< 0.5, N = 378) and high-WHtR (≥ 0.5, N = 1663). Multivariable Cox proportional-hazard models were used to examine the association of WHtR with all-cause death. Results The average age was 76.63 ± 11.44 years, and the mean follow-up was 4.53 years. During follow-up, 185 patients (9.06%) reached the primary outcome of all-cause death. As for the secondary outcome, 79 patients (3.87%) experienced cardiovascular death, 106 (5.19%) had non-cardiovascular death, and 94 (4.61%) had heart failure rehospitalization. After multivariable adjustment, a higher WHtR was significantly associated with the increased risks of all-cause death [adjusted hazard ratios (HR) 1.91, 95% confidence interval (CI) 1.06–3.45, p = 0.032], cardiovascular death (adjusted HR 2.58; 95% CI 1.01–6.67, p = 0.048), and HF rehospitalization (adjusted HR 3.04; 95% CI 1.26–7.31, p = 0.013). Conclusions Higher WHtR is an independent risk factor for all-cause death in Chinese patients with HFpEF.

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Body Composition, Natriuretic Peptides, and Adverse Outcomes in Heart Failure With Preserved and Reduced Ejection Fraction

Cited by 42 publications

References 28 publications

NT-proBNP for Risk Prediction in Heart Failure

NT-proBNP for Risk Prediction in Heart Failure

Diagnostic and prognostic considerations for use of natriuretic peptides in obese patients with heart failure

Waist to height ratio is associated with an increased risk of mortality in Chinese patients with heart failure with preserved ejection fraction

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