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European Heart Journal Advance Access published online on September 2, 2008
European Heart Journal, doi:10.1093/eurheartj/ehn388
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Relation of N-terminal pro-brain natriuretic peptide levels and their prognostic power in chronic stable heart failure to obesity status

Lutz Frankenstein1,*, Andrew Remppis1, Manfred Nelles1, Bernd Schaelling1, Dieter Schellberg2, Hugo Katus1 and Christian Zugck1

1 Department of Cardiology, Angiology and Pulmonology, University of Heidelberg, INF 410, Heidelberg 69120, Germany
2 Department of Psychosomatic and General Internal Medicine, University of Heidelberg, INF 410, Heidelberg 69120, Germany

Received 13 April 2008; revised 14 July 2008; accepted 13 August 2008.

* Corresponding author. Tel: +49 6221 56 3 8895, Fax: +49 6221 56 6547, Email: lutz.frankenstein{at}med.uni-heidelberg.de

Aims: To investigate the relationship between body mass index (BMI) and N-terminal pro-brain natriuretic peptide (NTproBNP) level and resultant prognostic capacity in chronic heart failure (CHF) controlled for known confounders.

Methods and results: We formed 206 triplets of patients (n = 618) with stable systolic CHF matched with respect to age, sex, renal function (MDRD, modification of diet in renal disease formula), and NYHA class, each with a BMI >30 kg/m2 (group 3), 20–24.9 kg/m2 (group 1), and 25–29.9 kg/m2 (group 2). BMI conveys a 4% drop in NTproBNP per unit increase. This influence remained significant after correction for age, sex, MDRD, NYHA, heart rate, rhythm, and ejection fraction. NTproBNP remained an independent predictor of adverse outcome after correction for age, sex, BMI, NYHA, MDRD, and ejection fraction. Despite numerical differences, prognostic power was comparable between BMI groups (log-transformed NTproBNP; group 1: hazard ratio (HR) 1.435, 95% CI 1.046–1.967, {chi}2 5.02, P = 0.03; group 2: HR 1.604, 95% CI 1.203–2.138, {chi}2 10.36, P = 0.001; group 3: HR 1.735, 95% CI 1.302–2.313, {chi}2 14.12, P = 0.0002) (P = NS, all). An NTproBNP correction factor was calculated.

Conclusion: Even matched for NYHA, age, sex, and renal function, BMI exerts a significant and independent inverse influence on NTproBNP in patients with stable CHF. NTproBNP retained equal statistical power in all three BMI groups.

Key Words: Chronic heart failure • NTproBNP • Obesity • Body mass index • Prognosis


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