Abstract 16598: BNP as a Prognostic Marker in Obese Patients With Acute Heart Failure With Preserved vs. Reduced Ejection Fraction
Introduction: Both obesity and preserved left ventricular ejection fraction (EF) are associated with lower BNP levels in heart failure (HF) patients. The prognostic utility of BNP in these cases is not well studied. Accordingly, we examined the distribution and prognostic association of BNP levels across BMI categories in HF with preserved EF (HFpEF) and HF with reduced EF (HFrEF).
Methods: The Atherosclerosis Risk in Communities (ARIC) HF community surveillance study sampled patients aged ≥ 55 years from 4 US communities with potential HF hospitalizations (ICD discharge code ‘428’) in 2005-2009. Patients with acute decompensated HF (ADHF), confirmed by a standardized panel of physicians, were categorized as HFpEF (EF > 50%) or HFrEF (< 50%). We examined 5 BMI categories: underweight (< 18.5 kg/m2), normal weight (18.5-24.99), overweight (25-29.99), obese (30-39.99) and morbidly obese (≥ 40). Patients on dialysis were excluded. The outcome was 1-year mortality from admission. We used ANCOVA to model log10 BNP and logistic regression for 1-year mortality, both adjusted for demographics and clinical characteristics, and weighted to account for the stratified random sample.
Results: The study group included 2086 ADHF hospitalizations with no missing covariates, corresponding to 10384 weighted hospitalizations (57% HFrEF; 43% HFpEF). BNP levels were lower in HFpEF compared to HFrEF (p < 0.001) and decreased as BMI increased within the 2 EF groups (p < 0.001, Figure). Overall, 9% of patients had BNP level < 200 pg/ml (14% in HFpEF; 19% in HFpEF and BMI > 30). After adjustment for covariates, log10 BNP independently predicted 1-year mortality in both EF groups, with no significant interaction with BMI categories (per 10-fold increase in BNP, OR = 1.66; 95% CI: 1.19-2.32).
Conclusions: Although BNP levels are lower in obese patients and in HFpEF with ADHF, BNP is an independent predictor of 1-year mortality across BMI and EF categories.
- © 2013 by American Heart Association, Inc.