Effect of Obesity on B-Type Natriuretic Peptide Levels in Patients With Pulmonary Arterial Hypertension

Abstract

Increased plasma brain natriuretic peptide (BNP) levels are associated with greater hemodynamic impairment, poorer functional capacity, and reduced survival in patients with idiopathic pulmonary arterial hypertension (PAH). 1,2BNP correlates with the degree of right ventricular overload and dysfunction in patients with PAH.3 Thus, BNP has assumed an increasingly important clinical role in the evaluation of patients with PAH. 4 -6 Compared to leaner subjects, BNP levels are attenuated in obese subjects with left ventricular dysfunction, even in the presence of heart failure symptoms and increased left ventricular filling pressure. [7][8][9] Nonetheless, in patients with left-sided heart failure, BNP remains a clinically useful predictor of exercise intolerance, hemodynamic impairment, and mortality at all levels of body mass index (BMI), although lower cutpoints appear necessary for patients with an elevated BMI.7,10 Whether a similar interaction between BNP and obesity occurs in subjects with PAH is not known. The present study investigated the relation between BNP and BMI in patients with PAH.

Cystatin C: A potential biomarker for pulmonary arterial hypertension

“…6 However, the utility of BNP and NT-ProBNP as a PAH biomarker is confounded by false-negative readings in early PAH, attenuated levels in obesity and physiological elevations with age as well as female gender independent of cardiovascular status. [7][8][9][10][11][12] Consequently, identifying a PAH biomarker that overcomes these limitations remains an active area of investigation.…”

“…Blood‐based biomarkers of RV distress including brain natriuretic peptide (BNP) and its N‐terminal cleavage product, N‐terminal BNP (NT‐ProBNP), are utilized for the diagnosis and prognosis of PAH . However, the utility of BNP and NT‐ProBNP as a PAH biomarker is confounded by false‐negative readings in early PAH, attenuated levels in obesity and physiological elevations with age as well as female gender independent of cardiovascular status . Consequently, identifying a PAH biomarker that overcomes these limitations remains an active area of investigation.…”

A heart–adipose tissue connection in the regulation of energy metabolism

“…For example, the presence of detectable amounts of active brown adipocytes in humans has been linked to increased energy expenditure, improved glycaemic control and reduced fat mass. 19 [69][70][71] To take this work forward, direct interventional studies in humans are now needed to assess the metabolic effects of natriuretic peptide infusions, some of which could be given chronically over several days to weeks. Previous studies of the effects of infusions of natriuretic peptides in both animals and humans have largely focused on blood pressure, cardiac responses and kidney function (although some studies [10][11][12] have assessed the effects of natriuretic peptide infusion on energy utilization, in terms of the balance between fat and carbohydrate oxidation).…”

Prospective Observational Study of N-terminal Pro–Brain Natriuretic Peptide Levels in Obese and Nonobese Women during Pregnancy

“…Outside of pregnancy, NT-proBNP and BNP levels are significantly lower in obese patients both with and without heart failure. 7,[14][15][16] The use of a single, weight-blind cutoff may result in lower sensitivity for the diagnosis of heart failure or ventricular dysfunction in obese patients. 17 The 2022 American Heart Association/American College of -Cardiology/Heart Failure Society of America Guideline for the Management of Heart Failure suggests consideration of BMI in the interpretation of BNP and NT-proBNP levels in obese patients due to lower diagnostic sensitivity in this population.…”

“…Outside of pregnancy, NT-proBNP and BNP levels are significantly lower in obese patients both with and without heart failure. 7,[14][15][16] The use of a single, weight-blind cutoff may result in lower sensitivity for the diagnosis of heart failure or ventricular dysfunction in obese…”