title: Inverse Correlation of Venous Brain Natriuretic Peptide Levels with Body Mass Index Is due to Decreased Production.
abstract: OBJECTIVE
  The aim of this paper was to study the association between body mass index (BMI) and coronary sinus (CS) brain natriuretic peptide (BNP) levels in patients with heart failure and reduced systolic function (HFrEF).
  
  
  BACKGROUND
  There is an inverse relationship between systemic venous BNP (V-BNP) levels and BMI in patients with HFrEF. It is unclear whether this finding is due to decreased production or due to an increased metabolism of BNP. Since CS-BNP levels reflect BNP production, we hypothesized that assessing the correlation of CS-BNP levels with BMI would provide insight into the mechanism of this inverse relationship of V-BNP and BMI.
  
  
  METHODS
  We prospectively enrolled 54 subjects with HFrEF who were to undergo cardiac resynchronization device implantation. CS-BNP, V-BNP, and arterial BNP (A-BNP) levels were measured during the implant procedure. Subjects were divided into 2 groups based on their BMI (group 1: BMI <30 and group 2: BMI ≥30).
  
  
  RESULTS
  The mean age of the overall study group was 64 ± 10 years. Average BMI for group 1 was 25.8 ± 2.8 and 36.8 ± 4.6 for group 2 (p < 0.03). A history of hypertension was present in 55% (n = 26) of the subjects, while diabetes was reported in 31% (n = 15). Serum creatinine was 1.0 ± 0.2 mg/dL and TSH 2.1 ± 1.4 mIU/L. 79% of the subjects were receiving β-blockers, while 94% were receiving angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. The mean CS-BNP, V-BNP, and A-BNP levels in group 2 were significantly lower than in group 1 (286.2 ± 170.5 vs. 417.5 ± 247.5 pg/mL, p = 0.04; 126.6 ± 32.5 vs. 228 ± 96.4 pg/mL, p = 0.01; and 151.9 ± 28.6 vs. 242 ± 88.8 pg/mL, p = 0.04, respectively). Univariate analysis and multivariate regression adjusted for age, diabetes mellitus, sex, glomerular filtration rate, and left atrial size confirmed BMI as an independent predictor of CS-BNP levels (β = -0.372, p = 0. 03) in our study.
  
  
  CONCLUSIONS
  In this study, we demonstrate an inverse relationship between CS-BNP levels and BMI in patients with HFrEF. These findings suggest that the previously established inverse relationship between V-BNP and BMI is due to a decreased cardiac production of BNP in obese patients rather than from increased peripheral metabolism.
authors.affiliation: Division of Cardiovascular Diseases and Cardiovascular Research Institute, University of Kansas Hospital, Kansas City, KS, USA.
authors.forename: Zubair
authors.initials: Z
authors.lastname: Shah
authors.forename: Mark
authors.initials: M
authors.lastname: Wiley
authors.forename: Arun Mahankali
authors.initials: AM
authors.lastname: Sridhar
authors.forename: Reza
authors.initials: R
authors.lastname: Masoomi
authors.forename: Mazda
authors.initials: M
authors.lastname: Biria
authors.forename: Dhananjay
authors.initials: D
authors.lastname: Lakkireddy
authors.forename: Buddhadeb
authors.initials: B
authors.lastname: Dawn
authors.forename: Kamal
authors.initials: K
authors.lastname: Gupta
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D058406:Cardiac Resynchronization Therapy / Q000379:methods; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011446:Prospective Studies; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000628:therapy*
chemical_list: D000319:Adrenergic beta-Antagonists; D015415:Biomarkers; D020097:Natriuretic Peptide, Brain
keywords: Body mass index; Brain natriuretic peptide; Coronary sinus; Heart failure; Systolic dysfunction