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Effect of body mass index on diagnostic and prognostic usefulness of amino-terminal pro-brain natriuretic peptide in patients with acute dyspnea.
Arch Intern Med. 2007 Feb 26; 167(4):400-7.AI

Abstract

BACKGROUND

Amino (N)-terminal pro-brain natriuretic peptide (NT-proBNP) testing is useful for diagnostic and prognostic evaluation in patients with dyspnea. An inverse relationship between body mass index (BMI); (calculated as weight in kilograms divided by height in meters squared) and NT-proBNP concentrations has been described.

METHODS

One thousand one hundred three patients presenting to the emergency department with acute dyspnea underwent analysis. Patients were classified into the following 3 BMI categories: lean (<25.0), overweight (25.0-29.9), and obese (>/=30.0).

RESULTS

The NT-proBNP concentrations in the overweight and obese groups were significantly lower than in the lean patients, regardless of the presence of acute heart failure (P<.001). The positive likelihood ratio for an NT-proBNP-based diagnosis of acute heart failure was 5.3 for a BMI lower than 25.0, 13.3 for a BMI of 25.0 to 29.9, and 7.5 for a BMI of 30.0 or higher. A cut point of 300 ng/L had very low negative likelihood ratios in all 3 BMI categories (0.02, 0.03, and 0.08, respectively). Among decedents, the NT-proBNP concentrations were lower in the overweight and obese patients compared with the lean subjects (P<.001). Nonetheless, a single cut point of 986 ng/L strongly predicted 1-year mortality across the 3 BMI strata, regardless of the presence of acute heart failure (hazard ratios, 2.22, 3.06, and 3.69 for BMIs of <25.0, 25.0-29.9, and >/=30.0, respectively; all P<.004); the risk associated with a high NT-proBNP concentration was detected early and was sustained to a year after baseline in all 3 BMI strata (all P<.001).

CONCLUSIONS

In patients with and without acute heart failure, the NT-proBNP concentrations are relatively lower in overweight and obese patients with acute dyspnea. Despite this, the NT-proBNP concentration retains its diagnostic and prognostic capacity across all BMI categories.

Authors+Show Affiliations

Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma, Barcelona, Spain.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

17325303

Citation

Bayes-Genis, Antoni, et al. "Effect of Body Mass Index On Diagnostic and Prognostic Usefulness of Amino-terminal Pro-brain Natriuretic Peptide in Patients With Acute Dyspnea." Archives of Internal Medicine, vol. 167, no. 4, 2007, pp. 400-7.
Bayes-Genis A, Lloyd-Jones DM, van Kimmenade RR, et al. Effect of body mass index on diagnostic and prognostic usefulness of amino-terminal pro-brain natriuretic peptide in patients with acute dyspnea. Arch Intern Med. 2007;167(4):400-7.
Bayes-Genis, A., Lloyd-Jones, D. M., van Kimmenade, R. R., Lainchbury, J. G., Richards, A. M., Ordoñez-Llanos, J., Santaló, M., Pinto, Y. M., & Januzzi, J. L. (2007). Effect of body mass index on diagnostic and prognostic usefulness of amino-terminal pro-brain natriuretic peptide in patients with acute dyspnea. Archives of Internal Medicine, 167(4), 400-7.
Bayes-Genis A, et al. Effect of Body Mass Index On Diagnostic and Prognostic Usefulness of Amino-terminal Pro-brain Natriuretic Peptide in Patients With Acute Dyspnea. Arch Intern Med. 2007 Feb 26;167(4):400-7. PubMed PMID: 17325303.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of body mass index on diagnostic and prognostic usefulness of amino-terminal pro-brain natriuretic peptide in patients with acute dyspnea. AU - Bayes-Genis,Antoni, AU - Lloyd-Jones,Donald M, AU - van Kimmenade,Roland R J, AU - Lainchbury,John G, AU - Richards,A Mark, AU - Ordoñez-Llanos,Jordi, AU - Santaló,Miquel, AU - Pinto,Yigal M, AU - Januzzi,James L,Jr PY - 2007/2/28/pubmed PY - 2007/3/30/medline PY - 2007/2/28/entrez SP - 400 EP - 7 JF - Archives of internal medicine JO - Arch Intern Med VL - 167 IS - 4 N2 - BACKGROUND: Amino (N)-terminal pro-brain natriuretic peptide (NT-proBNP) testing is useful for diagnostic and prognostic evaluation in patients with dyspnea. An inverse relationship between body mass index (BMI); (calculated as weight in kilograms divided by height in meters squared) and NT-proBNP concentrations has been described. METHODS: One thousand one hundred three patients presenting to the emergency department with acute dyspnea underwent analysis. Patients were classified into the following 3 BMI categories: lean (<25.0), overweight (25.0-29.9), and obese (>/=30.0). RESULTS: The NT-proBNP concentrations in the overweight and obese groups were significantly lower than in the lean patients, regardless of the presence of acute heart failure (P<.001). The positive likelihood ratio for an NT-proBNP-based diagnosis of acute heart failure was 5.3 for a BMI lower than 25.0, 13.3 for a BMI of 25.0 to 29.9, and 7.5 for a BMI of 30.0 or higher. A cut point of 300 ng/L had very low negative likelihood ratios in all 3 BMI categories (0.02, 0.03, and 0.08, respectively). Among decedents, the NT-proBNP concentrations were lower in the overweight and obese patients compared with the lean subjects (P<.001). Nonetheless, a single cut point of 986 ng/L strongly predicted 1-year mortality across the 3 BMI strata, regardless of the presence of acute heart failure (hazard ratios, 2.22, 3.06, and 3.69 for BMIs of <25.0, 25.0-29.9, and >/=30.0, respectively; all P<.004); the risk associated with a high NT-proBNP concentration was detected early and was sustained to a year after baseline in all 3 BMI strata (all P<.001). CONCLUSIONS: In patients with and without acute heart failure, the NT-proBNP concentrations are relatively lower in overweight and obese patients with acute dyspnea. Despite this, the NT-proBNP concentration retains its diagnostic and prognostic capacity across all BMI categories. SN - 0003-9926 UR - https://www.unboundmedicine.com/medline/citation/17325303/Effect_of_body_mass_index_on_diagnostic_and_prognostic_usefulness_of_amino_terminal_pro_brain_natriuretic_peptide_in_patients_with_acute_dyspnea_ DB - PRIME DP - Unbound Medicine ER -