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How obesity affects the cut-points for B-type natriuretic peptide in the diagnosis of acute heart failure. Results from the Breathing Not Properly Multinational Study.
Am Heart J. 2006 May; 151(5):999-1005.AH

Abstract

BACKGROUND

B-type natriuretic peptide (BNP) is valuable in diagnosing heart failure (HF), but its utility in obese patients is unknown. Studies have suggested a cut-point of BNP > or = 100 pg/mL for the diagnosis of HF; however, there is an inverse relation between BNP levels and body mass index. We evaluated differential cut-points for BNP in diagnosing acute HF across body mass index levels to determine whether alternative cut-points can improve diagnosis.

METHODS

The Breathing Not Properly Multinational Study was a 7-center, prospective study of 1586 patients who presented to the Emergency Department with acute dyspnea. B-type natriuretic peptide was measured on arrival. Height and weight data were available for 1368 participants. The clinical diagnosis of HF was adjudicated by 2 independent cardiologists who were blinded to BNP results.

RESULTS

Heart failure was the final diagnosis in 46.1%. Mean BNP levels (pg/mL) in lean, overweight/obese, and severely/morbidly obese patients were 643, 462, and 247 for patients with acute HF, and 52, 35, and 25 in those without HF, respectively (P < .05 for all comparisons except 35 vs 25). B-type natriuretic peptide cut-points to maintain 90% sensitivity for a HF diagnosis were 170 pg/mL for lean subjects, 110 pg/mL for overweight/obese subjects, and 54 pg/mL in severely/morbidly obese patients.

CONCLUSIONS

Body mass index influences the selection of cut-points for BNP in diagnosing acute HF. A lower cut-point (BNP > or = 54 pg/mL) should be used in severely obese patients to preserve sensitivity. A higher cut-point in lean patients (BNP > or = 170 pg/mL) could be used to increase specificity.

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Authors+Show Affiliations

Daniels LB
University of California, San Diego, CA, USA.
Clopton P
No affiliation info available
Bhalla V
No affiliation info available
Krishnaswamy P
No affiliation info available
Nowak RM
No affiliation info available
McCord J
No affiliation info available
Hollander JE
No affiliation info available
Duc P
No affiliation info available
Omland T
No affiliation info available
Storrow AB
No affiliation info available
Abraham WT
No affiliation info available
Wu AH
No affiliation info available
Steg PG
No affiliation info available
Westheim A
No affiliation info available
Knudsen CW
No affiliation info available
Perez A
No affiliation info available
Kazanegra R
No affiliation info available
Herrmann HC
No affiliation info available
McCullough PA
No affiliation info available
Maisel AS
No affiliation info available

MeSH

Acute DiseaseAgedBody Mass IndexCohort StudiesDyspneaFemaleHeart FailureHumansMaleMiddle AgedMulticenter Studies as TopicNatriuretic Peptide, BrainObesitySensitivity and SpecificitySeverity of Illness IndexSingle-Blind Method

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16644321

Citation

Daniels, Lori B., et al. "How Obesity Affects the Cut-points for B-type Natriuretic Peptide in the Diagnosis of Acute Heart Failure. Results From the Breathing Not Properly Multinational Study." American Heart Journal, vol. 151, no. 5, 2006, pp. 999-1005.
Daniels LB, Clopton P, Bhalla V, et al. How obesity affects the cut-points for B-type natriuretic peptide in the diagnosis of acute heart failure. Results from the Breathing Not Properly Multinational Study. Am Heart J. 2006;151(5):999-1005.
Daniels, L. B., Clopton, P., Bhalla, V., Krishnaswamy, P., Nowak, R. M., McCord, J., Hollander, J. E., Duc, P., Omland, T., Storrow, A. B., Abraham, W. T., Wu, A. H., Steg, P. G., Westheim, A., Knudsen, C. W., Perez, A., Kazanegra, R., Herrmann, H. C., McCullough, P. A., & Maisel, A. S. (2006). How obesity affects the cut-points for B-type natriuretic peptide in the diagnosis of acute heart failure. Results from the Breathing Not Properly Multinational Study. American Heart Journal, 151(5), 999-1005.
Daniels LB, et al. How Obesity Affects the Cut-points for B-type Natriuretic Peptide in the Diagnosis of Acute Heart Failure. Results From the Breathing Not Properly Multinational Study. Am Heart J. 2006;151(5):999-1005. PubMed PMID: 16644321.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - How obesity affects the cut-points for B-type natriuretic peptide in the diagnosis of acute heart failure. Results from the Breathing Not Properly Multinational Study. AU - Daniels,Lori B, AU - Clopton,Paul, AU - Bhalla,Vikas, AU - Krishnaswamy,Padma, AU - Nowak,Richard M, AU - McCord,James, AU - Hollander,Judd E, AU - Duc,Philippe, AU - Omland,Torbjørn, AU - Storrow,Alan B, AU - Abraham,William T, AU - Wu,Alan H B, AU - Steg,Philippe G, AU - Westheim,Arne, AU - Knudsen,Cathrine Wold, AU - Perez,Alberto, AU - Kazanegra,Radmila, AU - Herrmann,Howard C, AU - McCullough,Peter A, AU - Maisel,Alan S, PY - 2005/04/19/received PY - 2005/10/20/accepted PY - 2006/4/29/pubmed PY - 2006/5/27/medline PY - 2006/4/29/entrez SP - 999 EP - 1005 JF - American heart journal JO - Am Heart J VL - 151 IS - 5 N2 - BACKGROUND: B-type natriuretic peptide (BNP) is valuable in diagnosing heart failure (HF), but its utility in obese patients is unknown. Studies have suggested a cut-point of BNP > or = 100 pg/mL for the diagnosis of HF; however, there is an inverse relation between BNP levels and body mass index. We evaluated differential cut-points for BNP in diagnosing acute HF across body mass index levels to determine whether alternative cut-points can improve diagnosis. METHODS: The Breathing Not Properly Multinational Study was a 7-center, prospective study of 1586 patients who presented to the Emergency Department with acute dyspnea. B-type natriuretic peptide was measured on arrival. Height and weight data were available for 1368 participants. The clinical diagnosis of HF was adjudicated by 2 independent cardiologists who were blinded to BNP results. RESULTS: Heart failure was the final diagnosis in 46.1%. Mean BNP levels (pg/mL) in lean, overweight/obese, and severely/morbidly obese patients were 643, 462, and 247 for patients with acute HF, and 52, 35, and 25 in those without HF, respectively (P < .05 for all comparisons except 35 vs 25). B-type natriuretic peptide cut-points to maintain 90% sensitivity for a HF diagnosis were 170 pg/mL for lean subjects, 110 pg/mL for overweight/obese subjects, and 54 pg/mL in severely/morbidly obese patients. CONCLUSIONS: Body mass index influences the selection of cut-points for BNP in diagnosing acute HF. A lower cut-point (BNP > or = 54 pg/mL) should be used in severely obese patients to preserve sensitivity. A higher cut-point in lean patients (BNP > or = 170 pg/mL) could be used to increase specificity. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/16644321/How_obesity_affects_the_cut_points_for_B_type_natriuretic_peptide_in_the_diagnosis_of_acute_heart_failure__Results_from_the_Breathing_Not_Properly_Multinational_Study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-8703(05)00948-8 DB - PRIME DP - Unbound Medicine ER -