{
  "abstract": "Background and aims Obesity is associated with lower N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentration, possibly because obese patients become symptomatic with less severe left ventricular dysfunction. We explored the relation among body mass index (BMI), left ventricular ejection fraction (LVEF), symptoms, NT-proBNP and mortality in ambulatory patients investigated for suspected heart failure (HF).Methods Between 2001 and 2023, patients referred to a community HF clinic had age, sex, BMI, plasma NT-proBNP, serum creatinine, LVEF, New York Heart Association (NYHA) class, cardiac rhythm and systolic blood pressure recorded. Patients were categorised as ‘lean’ BMI <25 kg/m 2, ‘overweight’ BMI 25–29.9 kg/m2 or ‘obese’ BMI ≥30 kg/m2.Results Among 2866 patients (mean age 71±11 years; 63% men), NT-proBNP concentrations were inversely related to BMI after adjustment for age, sex, LVEF, renal function, rhythm, symptoms and blood pressure (p<0.001). Each 5 kg/m² increase in BMI was associated with a 13% (95% CI 10% to 17%) lower NT-proBNP. Within each NYHA class and across most LVEF values, patients with higher BMI had lower NT-proBNP concentrations. However, within NT-proBNP strata, BMI was not associated with mortality. Patients with NT-proBNP <125 ng/L had <1% 1-year mortality, irrespective of BMI.Conclusions In ambulatory patients with suspected HF, higher BMI is associated with lower NT-proBNP concentrations but does not attenuate the prognostic value of NT-proBNP. Lowering guideline-recommended NT-proBNP thresholds for obese patients is unlikely to identify individuals at higher mortality risk.",
  "authors": [
    {
      "affiliations": [
        "Hull University Teaching Hospitals NHS Trust, Hull, UK",
        "Centre for Clinical Sciences, Hull York Medical School, Hull, UK"
      ],
      "name": "Elton Luo"
    },
    {
      "affiliations": [
        "Hull University Teaching Hospitals NHS Trust, Hull, UK",
        "Centre for Clinical Sciences, Hull York Medical School, Hull, UK"
      ],
      "name": "Joseph James Cuthbert"
    },
    {
      "affiliations": [
        "Hull York Medical School, Hull, UK"
      ],
      "name": "Syed Kazmi"
    },
    {
      "affiliations": [
        "Hull York Medical School, Hull, UK"
      ],
      "name": "Alan S Rigby"
    },
    {
      "affiliations": [
        "University of Glasgow School of Cardiovascular & Metabolic Health, Glasgow, UK"
      ],
      "name": "Pierpaolo Pellicori"
    },
    {
      "affiliations": [
        "University of Glasgow School of Cardiovascular & Metabolic Health, Glasgow, UK"
      ],
      "name": "John G Cleland"
    },
    {
      "affiliations": [
        "Hull University Teaching Hospitals NHS Trust, Hull, UK"
      ],
      "name": "Andrew L Clark"
    }
  ],
  "title": "Association between body mass index, plasma N-terminal pro-B-type natriuretic peptide, symptoms and outcome in patients referred for investigation of suspected heart failure",
  "uid": "9ceb5b79-e727-5f1f-90d7-b1c821548436"
}