Obese subjects with heart failure have lower N‐terminal pro‐brain natriuretic peptide plasma levels irrespective of aetiology

Rivera, Miguel; Cortés, Raquel; Salvador, Antonio; Bertoméu, Vicente; Burgos, Fernando Garcı́a de; Payá, Rafael; Portolés, Manuel; Taléns‐Visconti, Raquel; Dolz, Luis Martínez; Valero, Ricardo; Sevilla, Begoña; Climent, Vicente

doi:10.1016/j.ejheart.2005.04.003

Cited by 47 publications

(33 citation statements)

References 9 publications

(12 reference statements)

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“…The majority of studies [12,21,22] have shown a negative correlation between plasma BNP concentrations and obesity in adults, both male and female, with and without heart failure, compared to the normal BMI individuals. A similarly inverse association was confirmed recently for NT-proBNP and BMI [23,24] and this relation was considered a potential link between obesity and hypertension. The investigators reasoned that obese patients with lower BNP levels at given levels of cardiac wall stress might lose the vasodilatory benefit of a high BNP.…”

Section: Discussionsupporting

confidence: 73%

Gender Dimorphic Associations between N-Terminal Pro-Brain Natriuretic Peptide, Body Mass Index and Blood Pressure in Children and Adolescents

et al. 2010

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Background: Obesity and hypertension are often comorbid, but the pathophysiologic mechanisms that link them are not fully understood. Natriuretic peptides might play a role in this association. The majority of studies show lower brain natriuretic peptide (BNP) concentrations as well as lower concentrations of the N-terminal of the prohormone (NT-proBNP) in obese than normal body mass index (BMI) adults and higher BNP concentrations in hypertensive than in normotensive individuals. In children, there are no studies examining the relations between NT-proBNP, BMI and blood pressure. Materials and Methods: Ninety-six children, 24 obese/25 normal BMI boys, and 23 obese/24 normal BMI girls, aged 10–16 years, were studied. Plasma NT-proBNP was measured using electrochemiluminescence. Results: In males, NT-proBNP concentrations were lower in the obese than the normal BMI group but higher in the obese hypertensive than the obese normotensive group (p = 0.04). In addition, a significant positive correlation was noted between plasma NT-proBNP and blood pressure (p = 0.03) only in obese males. In females, no correlations were detected between NT-proBNP, BMI and systolic or diastolic blood pressure. Conclusions: Longitudinal studies are needed to define the role of NT-proBNP as a screening biomarker in obese children, particularly males, to determine their risk for developing arterial hypertension.

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Section: Discussionsupporting

confidence: 73%

Gender Dimorphic Associations between N-Terminal Pro-Brain Natriuretic Peptide, Body Mass Index and Blood Pressure in Children and Adolescents

et al. 2010

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“…BNP levels are generally lower despite higher LV end-diastolic pressures in the obese and people with metabolic syndrome, whether they have CHF or not. [119][120][121][122][123] However, if this is taken into account, BNP retains similar diagnostic significance in obese subjects as in non-obese subjects. 124 Exercise capacity is not a good guide to the origin of breathlessness, as morbid obesity and chronic heart failure are both associated with a similar reduction in exercise capacity, and decreasing exercise capacity is related just as strongly to an adverse prognosis in both groups.…”

Section: Diagnostic Difficultiesmentioning

confidence: 99%

Review article: Left ventricular dysfunction and heart failure in metabolic syndrome and diabetes without overt coronary artery disease — do we need to screen our patients?

Roberts

Clark

Witte

2009

Diabetes and Vascular Disease Research

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The metabolic syndrome and its components, glucose intolerance, T2DM, hypertension, dyslipidaemia and obesity are increasingly common. Patients with the metabolic syndrome have a higher prevalence of chronic heart failure (CHF) and, once diagnosed, CHF in such subjects is associated with a higher mortality than in those without this co-morbidity. However, early diagnosis of LV systolic dysfunction and symptomatic heart failure may prevent deterioration of heart failure and improve prognosis. The aim of this article is to summarise the prevalence of CHF in people with obesity, hypertension and T2DM, and to review how each co-morbid condition might predispose to and complicate the clinical diagnosis of CHF.

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“…Another potential limitation to the use of BNP is in patients who are obese (body mass index of 30 kg/m 2 or greater). Various studies (38)(39)(40)(41)(42) have demonstrated that BNP (and NT-proBNP) levels are lower in obese patients, with and without heart failure, than in nonobese comparators. The mechanisms behind lower circulating BNP levels in obese patients are unclear, but may include decreased production combined with increased clearance of BNP.…”

Section: Bnp Versus Nt-probnpmentioning

confidence: 99%

Combining tissue Doppler echocardiography and B-type natriuretic peptide in the evaluation of left ventricular filling pressures: Review of the literature and clinical recommendations

Dokainish¹

2007

Canadian Journal of Cardiology

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Dyspnea is a common presenting symptom in patients seeking medical attention. However, determining the exact cause of dyspnea in a given patient can prove to be difficult, especially in patients with a noncardiac cause of dyspnea in the setting of known cardiac disease. Although invasively measured left ventricular (LV) filling pressure is the reference standard for establishing that pulmonary venous pressure elevation is contributing to symptoms of dyspnea in a given patient, it is not clinically feasible to subject all patients presenting with dyspnea to cardiac catheterization. Therefore, noninvasive methods of estimating LV filling pressures -B-type natriuretic peptide (BNP) measurement and the tissue Doppler (TD)-derived transmitral early diastolic/annular velocity ratio (E/Ea) -have attracted attention. Both BNP and mitral E/Ea possess important strengths and limitations. Therefore, in certain clinical scenarios, combining these indexes is superior to using either in isolation. However, there has been, to date, no clear consensus on the optimal clinical use of BNP and E/Ea in patients presenting with dyspnea. Therefore, the present paper comprehensively reviews the current literature on BNP and E/Ea, and makes clinical recommendations on the optimal use of these variables in patients with dyspnea and suspected congestive heart failure (CHF). A BRIEF HISTORY OF TD IMAGINGTD imaging of the heart is a Doppler technique that measures the frequency of ultrasound returning from moving myocardium to estimate the velocity of the myocardial wall. In 1989, Isaaz et al (1) were the first to describe clinical applications of TD in cardiac disease, demonstrating that low myocardial velocities at the posterior mitral annulus correlated with abnormal posterior wall motion on LV angiography. Gulati et al (2) demonstrated in 1996 that TD systolic mitral annular velocities correlated with global LV ejection fraction (EF), as assessed by radionuclide ventriculography. It was then shown that TD-derived Ea correlated with the invasively measured LV time constant of relation (Tau), establishing Ea as a relatively load-independent measure of myocardial Consequently, mitral E/Ea can help to establish the presence of clinical congestive heart failure in patients with dyspnea. However, E/Ea has a significant 'gray zone', and is not well validated in nonsinus rhythm and mitral valve disease. B-type natriuretic peptide (BNP) is a protein released by the ventricles in the presence of myocytic stretch, and has been correlated to LV filling pressure and, independently, to other cardiac morphological abnormalities. In addition, BNP is significantly affected by age, sex, renal function and obesity. Given its correlation with multiple cardiac variables, BNP has high sensitivity, but low specificity, for the detection of elevated LV filling pressures. Taking into account the respective strengths and limitations of BNP and mitral E/Ea, algorithms combining them can be used to more accurately estimate LV filling pressures in patients presenti...

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Obese subjects with heart failure have lower N‐terminal pro‐brain natriuretic peptide plasma levels irrespective of aetiology

Cited by 47 publications

References 9 publications

Gender Dimorphic Associations between N-Terminal Pro-Brain Natriuretic Peptide, Body Mass Index and Blood Pressure in Children and Adolescents

Gender Dimorphic Associations between N-Terminal Pro-Brain Natriuretic Peptide, Body Mass Index and Blood Pressure in Children and Adolescents

Review article: Left ventricular dysfunction and heart failure in metabolic syndrome and diabetes without overt coronary artery disease — do we need to screen our patients?

Combining tissue Doppler echocardiography and B-type natriuretic peptide in the evaluation of left ventricular filling pressures: Review of the literature and clinical recommendations

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