Usefulness of Plasma BNP Levels as a Marker of Left Ventricular Wall Stress in Obese Individuals

Tosa, Shinya; Watanabe, Hiroyuki; Iino, Kenji; Terui, Gen; Kosaka, Toshimitsu; Hasegawa, Hitoshi; Itoh, Hiroshi

doi:10.1536/ihj.50.173

Cited by 11 publications

(15 citation statements)

References 19 publications

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“…Most of the studies that observed obesity revealed a negative correlation between BMI and BNP (Clerico et al, 1999;Taylor et al, 2006;Tosa et al, 2009;Khan et al, 2011;Koizumi et al, 2011;Clerico et al, 2012). This correlation is referred to "natriuretic handicap phenomenon".…”

Section: Discussionmentioning

confidence: 99%

“…Overweight and obese individuals have an increased cardiovascular mortality risk than lean subjects (Wang et al, 2007). Plasma BNP/NT-proBNP values are inversely related to body mass index (BMI) in both healthy subjects and patients with heart failure (Hubert et al, 1983;Clerico et al, 1999;Taylor et al, 2006;Tosa et al, 2009;Clerico et al, 2012). Several studies have reported various association of natriuretic peptides levels with insulin resistance (Olsen et al, 2005;Alcelik et al, 2007;Wang et al, 2007;Tassone et al, 2009).…”

Section: Introductionmentioning

confidence: 99%

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N-terminal pro-B-type natriuretic peptide and insulin resistance in overweight and obese subjects

Alçelik¹,

Aytekin²,

Tosun³

et al. 2012

jecm

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ÖZETFarklı obez popülasyonlarda B-tip natriüretik peptid (BNP) seviyelerini araştıran bazı çalışmalar yapılmıştır. Henüz tam açıklanamayan bir mekanizma ile obezlerde BNP düzeyleri sıklıkla düşük olarak saptanmaktadır. Bilinen kalp hastalığı olmayan bireylerde plazma NT-proBNP seviyeleri, obezite ve insülin direnci arasındaki ilişkiyi araştırmayı amaçladık. Çalışma popülasyonumuz iki gruptan oluşmaktaydı. Vücut kitle indeksi (VKİ) ≤25 kg/m 2 olanlar zayıf grubuna (LG, n=30), >25 kg/m 2 olanlar ise fazla kilolu ve obez grubuna (OG, n=78) alındı. Ciddi hipertansiyonu, kalp yetmezliği, iskemik kalp hastalığı, böbrek veya karaciğer yetmezliği, malignitesi olan hastalar, gebeler ve 65 yaş üstü hastalar çalışmaya alınmadı. Zayıf hastaların grubunda NT-proBNP ile kilo (r=-0,379, p=0,004) ve VKİ (r=-0,286, p=0,030) arasında negatif bir ilişki varken, obez grupta NT-proBNP ve VKİ arasında böyle bir ters korelasyon saptanmadı. Obezite seviyelerinin belirteçlerini saptamak için çok değişkenli lojistik regresyon analizleri yaptık. Bu belirteçler ile obezite arasında anlamlı ilişki saptanmadı. İnsülin seviyelerinin obezite ile güçlü bir ilişkisi vardı ancak yine de bu ilişki istatistiksel anlamlılık düzeylerine ulaşamıyordu (p=0,054). Zayıf hasta grubunda NT-proBNP ve VKİ arasında ters korelasyon vardı. Aynı grupta NT-proBNP ve homeastatik modelde değerlendirme (HOMA) ve insülin seviyeleri (r=-0,035, p=0,789) arasında korelasyon yoktu, ancak obez grupta BNP ve HOMA (r=-0,219, p=0,009) ve insulin seviyeleri (r=-0,252, p=0,002) arasında istatistiksel olarak anlamlı ters ilişki vardı. Irk ve etnik köken bu farklılığa katkıda bulunuyor olabilir. Several studies have been conducted to investigate B-type natriuretic peptide (BNP) levels in different obese populations. However, in these studies BNP levels were lower in obese population with an unclear mechanism which has not been explained yet. We sought to investigate the relationship among plasma NT-proBNP levels, obesity and insulin resistance in subjects with no known heart disease. The study population consists of two groups. Subjects with a body mass indexs (BMI) of ≤25 kg/m 2 were classified as lean group (LG, n=30), BMI of >25 kg/m 2 were classified as overweight and obese group (OG, n=78). Severe hypertension, heart failure, ischemic heart disease, renal or hepatic insufficiency, age >65, pregnancy and malignancy were excluded. There was a negative correlation between NT-proBNP and weight (r=-0.379, p=0.004) and BMI (r=-0.286, p=0.030) in LG, but there was no such reverse correlation between NT-proBNP and BMI (r=-0.057, p=0.463) in OG. We performed multivariable logistic regression analyses to examine predictors of obesity levels. There were not any significant relation between these predictors and obesity. Insulin levels had a strong association with obesity level however this association was still insignificant (p=0.054). In LG group, there was a negative correlation between NT-proBNP and BMI. There was no correlation between NT-proBNP and homeostatic model assessment ...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

N-terminal pro-B-type natriuretic peptide and insulin resistance in overweight and obese subjects

Alçelik¹,

Aytekin²,

Tosun³

et al. 2012

jecm

View full text Add to dashboard Cite

show abstract

“…Plasma BNP levels, BMI and AC Plasma BNP levels are inversely related to BMI in individuals with and without heart failure [7][8][9][10][11]. One proposed mechanism is that adipose tissue contains an abundance of natriuretic peptide clearance receptor (NPC-R), leading to lower BNP concentrations in obese patients who have larger amounts of adipose tissue [7][8][9][10][11].…”

Section: Principal Findingsmentioning

confidence: 99%

“…Plasma BNP levels are a strong marker of left ventricular dysfunction, in addition to a marker for accurately predicting morbidity and mortality in patients with heart failure [3][4][5][6]. Plasma BNP levels are inversely related to body mass index (BMI) in individuals with and without heart failure [7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

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Impact of obesity on plasma B-type natriuretic peptide levels in Japanese community-based subjects

et al. 2011

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The plasma B-type natriuretic peptide (BNP) concentration was recently shown to be inversely correlated with body mass index (BMI). However, very few attempts have been made to associate abdominal obesity and BNP in the Japanese general population. Here, we conducted a cross-sectional study, and examined 339 male and 429 female residents without heart disease in a rural Japanese community who received an annual health checkup in 2006. BNP was inversely associated with both BMI and abdominal circumference (AC) in the age-adjusted regression analysis (p < 0.05). Following adjustment for traditional risk factors, multiple regression analysis revealed that BNP was negatively correlated with AC (p < 0.05), but not BMI. Although metabolic syndrome was not associated with BNP levels, AC had an influence on low BNP levels in the multiple regression analysis using both AC and BMI concurrently (p < 0.05 for AC and p > 0.60 for BMI). These effects were more prominent in men than in women. Collectively, plasma BNP levels are inversely related with obesity, as measured by AC, in Japanese community-based subjects.

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The conundrum of patients with obesity, exercise intolerance, elevated ventricular filling pressures and a measured ejection fraction in the normal range

Packer

2018

European J of Heart Fail

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Patients with obesity, a reduced exercise capacity, increased cardiac filling pressures and a measured left ventricular ejection fraction in the normal range do not have a homogeneous disorder, but instead, exhibit one of three phenotypes. First, many obese people exhibit sodium retention, plasma volume expansion and cardiac enlargement, and some are likely to have heart failure that is related to hypervolaemia, even though cardiac index and circulating levels of natriuretic peptides are not meaningfully increased. Second, in some middle‐aged men and women (particularly those with minimal co‐morbidities), levels of natriuretic peptides increase markedly and can lower systemic vascular resistance, thus leading to high‐output heart failure (HOHF) and glomerular hyperfiltration. Third, older obese people, particularly women with multiple co‐morbidities, exhibit the syndrome of heart failure with a preserved ejection fraction (HFpEF). Despite degrees of plasma volume expansion similar to HOHF, these patients exhibit only modestly increased ventricular dimensions and circulating levels of natriuretic peptides (despite a high prevalence of atrial fibrillation), and glomerular function is characteristically impaired. A conceptual framework is proposed to distinguish among the three phenotypes seen in obese patients with exercise intolerance, increased ventricular filling pressures and a measured left ventricular ejection fraction in the normal range, since they may respond differently to therapeutic interventions. Efforts are needed to enhance the recognition of heart failure in obese people and to ensure that clinical trials that are designed to study patients with HFpEF actually enrol those who have the disease.

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Usefulness of Plasma BNP Levels as a Marker of Left Ventricular Wall Stress in Obese Individuals

Cited by 11 publications

References 19 publications

N-terminal pro-B-type natriuretic peptide and insulin resistance in overweight and obese subjects

N-terminal pro-B-type natriuretic peptide and insulin resistance in overweight and obese subjects

Impact of obesity on plasma B-type natriuretic peptide levels in Japanese community-based subjects

The conundrum of patients with obesity, exercise intolerance, elevated ventricular filling pressures and a measured ejection fraction in the normal range

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