Understanding amino-terminal pro-B-type natriuretic peptide in obesity.
Concentrations of both B-type natriuretic peptide (BNP) and its amino-terminal cleavage fragment (NT-proBNP) are relatively lower among patients with a higher body mass index (BMI). Based on data at hand, this is probably related to reduced synthesis or secretion of the peptides, rather than increased clearance (which may play only a minor role in this context). Despite this fact, age-adjusted NT-proBNP cut points to "rule in" heart failure (HF) and age-independent cut points to "rule out" HF in patients with acute dyspnea are equally useful for obese and lean patients, and no adjustment of NT-proBNP thresholds for BMI is recommended. Furthermore, the consensus-recommended NT-proBNP cut point of 1,000 ng/L for prognostication in acute dyspnea is equally useful across all BMI categories, without the need for further adjustment for weight. Thus, despite the BMI-related NP handicap observed in overweight and obese patients, NT-proBNP remains powerfully useful for diagnostic and prognostic evaluation across the entire range of BMI values.
Bayes-Genis
Antoni
A
Cardiology Service, Hospital Santa Creu i Sant Pau, Barcelona, Spain.
DeFilippi
Christopher
C
Januzzi
James L
JL
D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D006801:Humans; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D009765:Obesity / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D011498:Protein Precursors; D012720:Severity of Illness Index
D015415:Biomarkers; D010446:Peptide Fragments; D011498:Protein Precursors; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain