B-Type natriuretic peptide and N-terminal pro B-type natriuretic peptide are depressed in obesity despite higher left ventricular end diastolic pressures

doi:10.1016/j.ahj.2006.07.010

American Heart Journal

Volume 152, Issue 6, December 2006, Pages 1071-1076

https://doi.org/10.1016/j.ahj.2006.07.010 Get rights and content

Background

B-Type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) are frequently used in diagnosing and monitoring patients with heart failure. Recent studies have demonstrated that concentrations of these peptides are decreased in obese patients, but whether lower natriuretic peptide concentrations are really due to different hemodynamics is unknown. The relationship between these markers and left ventricular end diastolic pressure (LVEDP) in obesity has not been elucidated.

Methods

We examined patients undergoing cardiac catheterization who had creatinine of <2.0, no evidence of myocardial infarction or pulmonary embolism, and no cardiac transplant. Body mass index and LVEDP were determined, and BNP and NT-proBNP obtained at the start of each case. Obesity was defined as body mass index of ≥30 kg/m².

Results

Of 203 patients enrolled, 101 were obese. The groups were similar in respect to race, creatinine, cholesterol, and history of dyslipidemia and cardiomyopathy. The obese patients tended to be younger, were more likely to have diabetes and hypertension, and were less likely to have coronary artery disease. The obese patients had higher LVEDP but reduced BNP and NT-pro-BNP. The relationship between the natriuretic peptides and LVEDP was poor, with r values of <0.1.

Conclusions

Obese patients have reduced concentrations of BNP and NT-proBNP compared to nonobese patients despite having elevated LVEDP. This suggests that factors other than cardiac status impact on BNP and NT-proBNP concentrations. The poor relationship between natriuretic peptide concentrations and LVEDP also suggests that these concentrations should not be considered surrogates for cardiac filling pressures or volumes.

Section snippets

Study population

A total of 203 patients undergoing cardiac catheterization were enrolled in our study between September 2004 and October 2005. Exclusion criteria included acute myocardial infarction, acute pulmonary embolism, creatinine concentration of ≥2.0 mg/dL, and cardiac transplantation. All other patients were eligible for this study.

Patients were interviewed and records were reviewed to determine past medical history, medications, and pertinent laboratory values. The severity of CHF was categorized by

Patients

The study included 203 patients (aged 62 ± 14; 68% men; 76% white) undergoing cardiac catheterization. Of these, 50% were obese (BMI 37 ± 5 kg/m²) and 50% were nonobese (BMI 26 ± 3 kg/m²). The characteristics of the patients are described in Table I. Of note, 51% had a history of CAD and 80% had a history of hypertension. Only 57 patients (28%) had a prior history of CHF, defined as an ejection fraction of <40% or prior documented diastolic dysfunction. Of these, 27 (47%) were NYHA class I, 16

Discussion

The present study is the first to evaluate the relationship of LVEDP and natriuretic peptide measurements in obese and nonobese patients. It demonstrates that obesity is an independent determinant of both BNP and NT-proBNP concentrations. Both BNP and NT-proBNP concentrations were lower in obese patients despite higher LVEDP measurements. These findings have several implications. Not only do they bring into question the proper use of BNP and NT-proBNP as diagnostic tests for obese patients with

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Cited by (131)

Left Atrial Remodeling Related to Disproportionately Low B-Type Natriuretic Peptide in Acute Heart Failure Patients with Atrial Fibrillation
2023, American Journal of Cardiology
The diagnostic performance of B-type natriuretic peptide (BNP) for acute heart failure (HF) is impaired in patients with atrial fibrillation (AF). Increased AF burden in HF is associated with left atrial (LA) remodeling. Recent studies have revealed that LA remodeling may affect LV filling. We hypothesized that LA remodeling affects BNP secretion in acute HF conditions. The study investigated the clinical impact of LA remodeling on admission BNP levels in acute HF patients with and without AF. Consecutive acute HF hospitalized patients (n = 899) were divided into groups with (n = 382) or without AF (n = 507) and subdivided into disproportionately low BNP (LB) (≤200 pg/ml), medium BNP (200 to 600 pg/ml) and high BNP (≥600 pg/ml) subgroups. The AF group had a higher proportion of patients with LB than the non-AF group (23.6% vs 16.6%, p = 0.009). BNP levels in both groups were positively correlated with LV end-diastolic volume and negatively correlated with LV ejection fraction in both groups. In contrast, BNP was positively correlated with LA volume index in the non-AF group, but negatively correlated in the AF group. The survival rates were significantly higher in the LB group than in the other groups in non-AF. Conversely, there were no significant differences across all groups in AF patients. In conclusion, in patients with acute HF and AF, disproportionately low BNP levels are associated with LA structural remodeling and poor prognosis.
Descriptions and Determinants of N-Terminal Pro–B-Type Natriuretic Peptide in Pediatric CKD: The Chronic Kidney Disease in Children (CKiD) Study
2023, American Journal of Kidney Diseases
Natriuretic Peptides as Predictors of Protein-Energy Wasting in Hemodialysis Population
2022, Journal of Renal Nutrition
Imbalance between anabolism and catabolism is linked to cachexia and protein-energy wasting (PEW), especially in frail populations such as patients with chronic kidney disease. PEW is responsible of poor outcomes with increased morbidity and mortality. Several causes are involved in PEW such as insulin resistance, acidosis, or hyperparathyroidism. Natriuretic peptides (NPs) have recently been described as activators of resting energy expenditure through the induction of browning of white adipose tissue in rodents with chronic kidney disease. The present study was therefore implemented to investigate whether NPs could be associated with PEW criteria and predict clinical outcomes.
We quantified serum N-terminal pro–B-type natriuretic peptide (NT-proBNP) in a prospective cohort of 231 patients undergoing maintenance hemodialysis and atrial natriuretic peptide in a subgroup of 35 patients. Body composition parameters were measured with bioimpedance spectroscopy.
NT-proBNP was inversely associated with serum albumin, prealbumin, and body mass index and, conversely, positively associated with age and C-reactive protein. NT-proBNP as well as atrial natriuretic peptide were significantly higher in patients with PEW criteria. NT-proBNP was negatively associated with body fat mass. In multiple linear regression, NT-proBNP remained associated with body mass index. Kaplan-Meier analysis revealed a significant correlation between serum NT-proBNP concentrations and all-cause mortality and cardiovascular events. This association remained significant after multivariable Cox regression models adjusted for demographic factors and cardiovascular risk factors.
Accumulation of NPs seems to be associated with poor nutritional status and reduced survival among hemodialysis patients. Further studies are needed to confirm this association using resting energy expenditure measurement and adipose tissue biopsy.
Disproportionately low BNP levels in patients of acute heart failure with preserved vs. reduced ejection fraction
2021, International Journal of Cardiology
B-type natriuretic peptide (BNP) has been widely used for the diagnosis of heart failure, its severity, and prognosis. However, little is known about factors related to disproportionately low BNP levels even during acute heart failure conditions.
Among 424 patients hospitalized for acute heart failure, we categorized the patients into the HFpEF (LVEF > 50%) or HFrEF (LVEF ≤ 50%) group and subdivided them into disproportionately low BNP (LB) group and high BNP (HB) group using a cut-off BNP level of 200 pg/mL at admission. The proportion of patients with LB was higher in the HFpEF group (22.2%) than in the HFrEF group (10.9%, p = 0.002). Patients with LB had a high BMI, lower blood pressure, and history of previous cardiovascular surgery in the HFpEF group, while patients in the HFrEF group had a high BMI and smaller left ventricular end-diastolic volume index. Furthermore, presence of LB in the HFrEF group was related to good prognosis, but LB in the HFpEF group was an indicator of poor prognosis as HB group.
The factors associated with LB were different between the HFpEF and HFrEF groups. LB was related to good prognosis in HFrEF, but not in HFpEF.
Serum B-type natriuretic peptide does not increase with higher systolic blood pressure in obese men despite evidence of blood pressure-related increases in left ventricular mass and filling pressure
2020, Peptides
B-type natriuretic peptide (BNP) is a cardiac hormone secreted predominantly from the ventricles in response to increased ventricular pressure. Along this line, hypertensive patients with left ventricular hypertrophy typically have high circulating BNP concentrations. BNP has natriuretic and vasodilatory actions. Obese persons have low circulating BNP concentrations, and a relative lack of this natriuretic and vasodilatory factor could contribute to obesity-related hypertension. The relationship between BNP, BP, left ventricular mass (LVM), and left ventricular filling pressure among obese persons is not clear. To address this issue, we studied 98 healthy obese medication-free men with normal left ventricular ejection fraction. We measured BP using 24 -h ambulatory (A) BP recordings, LVM and E/e', an estimate of left ventricular filling pressure, using echocardiography, and fasting BNP in serum. Mean systolic ABP ± SD was 114 ± 4 mm Hg in 1^st and 149 ± 8 mm Hg in 4^th systolic ABP quartile, P < 0.001. LVM and E/e' increased across systolic ABP quartiles (mean LVM±SD: 81.5±13.7 g/m² in 1^st and 100.1 ± 26.7 g/m² in 4^th quartile, P = 0.018; mean E/e'±SD: 5.3±1.6 in 1^st and 7.0 ± 2.0 in 4^th quartile, P = 0.002). In contrast, serum BNP did not increase across systolic ABP quartiles (median (IQR): 6.7 (3.1-12.3) pg/ml in 1^st and 5.3 (2.8-9.7) pg/ml in 4^th quartile, P = 0.75). Unexpectedly, among healthy obese medication-free men, serum BNP does not increase with higher systolic ABP despite evidence of BP-related increases in LVM and E/e'. This further suggests that a relatively low amount of circulating BNP could contribute to obesity-related hypertension in its early stages.
Relationship between left ventricular preload and N-terminal pro-brain natriuretic peptide in obese patients
2020, Journal of Cardiology
The reason for low plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) levels in patients with a high body mass index (BMI) is unknown. Although left ventricular end-diastolic pressure (LVEDP) is the gold standard of preload, the estimated trans left ventricular end-diastolic transmural pressure (eLVTMP) may be true preload especially in obese patients.
We measured hemodynamic parameters and the plasma NT-proBNP level in the aortic root (AO) and coronary sinus (CS) in 602 left-sided heart disease patients. We defined normal as BMI < 25 kg/m² (n = 436), overweight as 25 ≤ BMI<30 kg/m² (n = 117), and obese as BMI ≥ 30 kg/m² (n = 49).
There were no significant differences in left ventricular ejection fraction (LVEF) or LVEDP among the three groups, and log (CSAO) NT-proBNP was significantly lower in overweight or obese patients than in normal patients. From stepwise multivariate analyses, eLVTMP (eLVTMP = LVEDPright atrial pressure), LVEF, and BMI were independent predictors of log (CSAO) NT-proBNP, but LVEDP was not. The eLVTMP was significantly lower in obese patients than in overweight patients (7.5 ± 5.1 vs. 9.6 ± 5.3 mmHg, p < 0.05) or normal patients (7.5 ± 5.1 vs. 9.6 ± 4.7 mmHg, p < 0.01).
Lower eLVTMP, as a marker of left ventricular preload, may contribute to the lower NT-proBNP secretion from the heart in obese patients.

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: This study was funded in part by a grant from Dade Behring, Inc, Glasgow, DE.

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Clinical InvestigationCongestive Heart FailureB-Type natriuretic peptide and N-terminal pro B-type natriuretic peptide are depressed in obesity despite higher left ventricular end diastolic pressures

Background

Methods

Results

Conclusions

Section snippets

Study population

Patients

Discussion

Am Heart J

Am Heart J

J Card Fail

Am J Cardiol

J Am Coll Cardiol

Am Heart J

Nutr Metab Cardiovasc Dis

Am Heart J

Am J Cardiol

Clin Lab Med

Am J Cardiol

Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure

N Engl J Med

Plasma N-terminal pro-brain natriuretic peptide and the ECG in the assessment of left-ventricular systolic dysfunction in a high risk population

Eur Heart J

Clinical Investigation
Congestive Heart Failure
B-Type natriuretic peptide and N-terminal pro B-type natriuretic peptide are depressed in obesity despite higher left ventricular end diastolic pressures