title: Impact of obesity on the prognostic value of the N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients with acute myocardial infarction.
abstract: OBJECTIVE
  To examine the influence of obesity on the predictive value of the pro-B-type natriuretic peptide (NT-proBNP) assay in acute myocardial infarction.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  All intensive care units in one region of France. Patients 2217 consecutive patients admitted for an acute myocardial infarction matched with respect to age, gender, Killip class and renal function.
  
  
  METHODS
  Cardiovascular death at one year.
  
  
  RESULTS
  There were three groups (according to body mass index (BMI): obese, overweight and normal) of 739 matched patients. Median levels of NT-proBNP were considerably lower in high BMI patients, by about 20% in overweight and by 60% in obese patients, compared with normal BMI patients. An inverse relationship between the propeptide values and BMI was found in the overall study population (r = -0.20, p < 0.0001), and for both genders. In multivariate linear regression, BMI as a continuous variable was a predictor of the log NT-proBNP level, even when adjusted for potential confounders. CV mortality at 1-year follow-up was similar for the three BMI groups (p = 0.691). In multivariate logistic regression analysis, log NT-proBNP predicted mortality in normal (OR (95% CI) 3.48 (2.00 to 6.12)) and overweight (OR (95% CI) 3.96 (1.95 to 8.06)) patients, even when adjusted for confounders (GRACE risk score, left ventricular ejection fraction). However, in obese patients, propeptide levels failed to retain their independent prognostic value (OR (95% CI) 1.34 (0.86 to 2.08)).
  
  
  CONCLUSIONS
  In this large population of patients with myocardial infarction, circulating NT-proBNP levels were considerably lower in obese patients; the significance of the propeptide level as an independent prognostic factor is severely compromised.
authors.affiliation: Department of Cardiology, University Hospital, CHU Dijon, Bd de Lattre de Tassigny, Dijon Cedex 21034, France. luc.lorgis@chu-dijon.fr
authors.forename: L
authors.initials: L
authors.lastname: Lorgis
authors.forename: Y
authors.initials: Y
authors.lastname: Cottin
authors.forename: N
authors.initials: N
authors.lastname: Danchin
authors.forename: L
authors.initials: L
authors.lastname: Mock
authors.forename: P
authors.initials: P
authors.lastname: Sicard
authors.forename: P
authors.initials: P
authors.lastname: Buffet
authors.forename: I
authors.initials: I
authors.lastname: L'huillier
authors.forename: C
authors.initials: C
authors.lastname: Richard
authors.forename: J C
authors.initials: JC
authors.lastname: Beer
authors.forename: C
authors.initials: C
authors.lastname: Touzery
authors.forename: P
authors.initials: P
authors.lastname: Gambert
authors.forename: M
authors.initials: M
authors.lastname: Zeller
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D009765:Obesity / Q000097:blood / Q000150:complications* / Q000401:mortality; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain