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Original article
Impact of obesity on the prognostic value of the N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients with acute myocardial infarction
  1. L Lorgis1,
  2. Y Cottin1,
  3. N Danchin2,
  4. L Mock3,
  5. P Sicard4,
  6. P Buffet1,
  7. I L'Huillier1,
  8. C Richard1,
  9. J C Beer1,
  10. C Touzery1,
  11. P Gambert5,
  12. M Zeller4,
  13. on behalf of the RICO survey working group
  1. 1Department of Cardiology, University Hospital, Dijon, France
  2. 2Department of Cardiology, Hôpital Européen Georges Pompidou, APHP, Université Rene Descartes Paris V, Paris, France
  3. 3Department of Cardiology, Clinique de Fontaine, Fontaine les Dijon, Dijon, France
  4. 4Laboratory of Cardiovascular and Experimental Physiopathology and Pharmacology, IFR santé STIC, University of Burgundy, Dijon, France
  5. 5Department of Medical Biochemistry, University Hospital, Dijon, France
  1. Correspondence to Luc Lorgis, Department of Cardiology, University Hospital, CHU Dijon, Bd de Lattre de Tassigny, Dijon Cedex 21034, France; luc.lorgis{at}chu-dijon.fr

Abstract

Objective To examine the influence of obesity on the predictive value of the pro-B-type natriuretic peptide (NT-proBNP) assay in acute myocardial infarction.

Design Prospective observational study.

Setting All intensive care units in one region of France.

Patients 2217 consecutive patients admitted for an acute myocardial infarction matched with respect to age, gender, Killip class and renal function.

Main outcome measure Cardiovascular death at one year.

Results There were three groups (according to body mass index (BMI): obese, overweight and normal) of 739 matched patients. Median levels of NT-proBNP were considerably lower in high BMI patients, by about 20% in overweight and by 60% in obese patients, compared with normal BMI patients. An inverse relationship between the propeptide values and BMI was found in the overall study population (r=−0.20, p<0.0001), and for both genders. In multivariate linear regression, BMI as a continuous variable was a predictor of the log NT-proBNP level, even when adjusted for potential confounders. CV mortality at 1-year follow-up was similar for the three BMI groups (p=0.691). In multivariate logistic regression analysis, log NT-proBNP predicted mortality in normal (OR (95% CI) 3.48 (2.00 to 6.12)) and overweight (OR (95% CI) 3.96 (1.95 to 8.06)) patients, even when adjusted for confounders (GRACE risk score, left ventricular ejection fraction). However, in obese patients, propeptide levels failed to retain their independent prognostic value (OR (95% CI) 1.34 (0.86 to 2.08)).

Conclusions In this large population of patients with myocardial infarction, circulating NT-proBNP levels were considerably lower in obese patients; the significance of the propeptide level as an independent prognostic factor is severely compromised.

  • Myocardial infarction
  • NT-proBNP
  • obesity
  • prognosis
  • STEMI

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Footnotes

  • Funding This work was supported by the University Hospital of Dijon, the Association de Cardiologie de Bourgogne, and by grants from the Union Régionale des Caisses d'Assurance Maladie de Bourgogne (URCAM), the Agence Regionale d'Hospitalisation (ARH) de Bourgogne, the Conseil Régional de Bourgogne and the Fédération Française de Cardiologie (FFC).

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the REC Committee of University Hospital Dijon.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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