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How obesity affects the cut-points for B-type natriuretic peptide in the diagnosis of acute heart failure. Results from the Breathing Not Properly Multinational Study.
MedLine Citation:
PMID:  16644321     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: B-type natriuretic peptide (BNP) is valuable in diagnosing heart failure (HF), but its utility in obese patients is unknown. Studies have suggested a cut-point of BNP > or = 100 pg/mL for the diagnosis of HF; however, there is an inverse relation between BNP levels and body mass index. We evaluated differential cut-points for BNP in diagnosing acute HF across body mass index levels to determine whether alternative cut-points can improve diagnosis. METHODS: The Breathing Not Properly Multinational Study was a 7-center, prospective study of 1586 patients who presented to the Emergency Department with acute dyspnea. B-type natriuretic peptide was measured on arrival. Height and weight data were available for 1368 participants. The clinical diagnosis of HF was adjudicated by 2 independent cardiologists who were blinded to BNP results. RESULTS: Heart failure was the final diagnosis in 46.1%. Mean BNP levels (pg/mL) in lean, overweight/obese, and severely/morbidly obese patients were 643, 462, and 247 for patients with acute HF, and 52, 35, and 25 in those without HF, respectively (P < .05 for all comparisons except 35 vs 25). B-type natriuretic peptide cut-points to maintain 90% sensitivity for a HF diagnosis were 170 pg/mL for lean subjects, 110 pg/mL for overweight/obese subjects, and 54 pg/mL in severely/morbidly obese patients. CONCLUSIONS: Body mass index influences the selection of cut-points for BNP in diagnosing acute HF. A lower cut-point (BNP > or = 54 pg/mL) should be used in severely obese patients to preserve sensitivity. A higher cut-point in lean patients (BNP > or = 170 pg/mL) could be used to increase specificity.
Lori B Daniels; Paul Clopton; Vikas Bhalla; Padma Krishnaswamy; Richard M Nowak; James McCord; Judd E Hollander; Philippe Duc; Torbjørn Omland; Alan B Storrow; William T Abraham; Alan H B Wu; Philippe G Steg; Arne Westheim; Cathrine Wold Knudsen; Alberto Perez; Radmila Kazanegra; Howard C Herrmann; Peter A McCullough; Alan S Maisel
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  American heart journal     Volume:  151     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2006 May 
Date Detail:
Created Date:  2006-04-28     Completed Date:  2006-05-26     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  999-1005     Citation Subset:  AIM; IM    
University of California, San Diego, CA, USA.
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MeSH Terms
Acute Disease
Body Mass Index
Cohort Studies
Dyspnea / complications
Heart Failure / blood*,  complications,  diagnosis*
Middle Aged
Multicenter Studies as Topic
Natriuretic Peptide, Brain / blood*
Obesity / blood*,  complications,  pathology,  physiopathology
Sensitivity and Specificity
Severity of Illness Index
Single-Blind Method
Reg. No./Substance:
114471-18-0/Natriuretic Peptide, Brain

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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