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Background Heart failure with preserved ejection fraction (HF pEF ) constitutes half of hospitalizedheart failure cases and is commonly associated with obesity. The role of natriuretic peptide levels in hospitalized obese patients withHF pEF , however, is not well defined. We sought to evaluate change inNT ‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) levels by obesity category and related clinical outcomes inpatients with HF pEF hospitalized for acute heart failure.Methods and Results A total of 89patients with HF pEF hospitalized with acute decompensatedheart failure were stratified into 3 obesity categories: nonobese (body mass index [BMI] &lt;30.0 kg/m2 , 19%), obese (BMI 30.0–39.9 kg/m2 , 29%), and severely obese (BMI ≥40.0 kg/m2 , 52%), and compared for percent change inNT ‐proBNP during hospitalization and clinical outcomes. Clinical characteristics were compared between patients with normalNT ‐proBNP (≤125 pg/mL ) and elevatedNT ‐proBNP . AdmissionNT ‐proBNP was inversely related toBMI category (nonobese, 2607 pg/mL [interquartile range, IQR: 2112–5703]; obese, 1725 pg/mL [IQR: 889–3900]; and severely obese, 770.5 pg/mL [IQR: 128–1268];P &lt;0.01). Severely obese patients had the largest percent change inNT ‐proBNP with diuresis (−64.8% [95% CI, −85.4 to −38.9] versus obese −40.4% [95% CI, −74.3 to −12.0] versus nonobese −46.9% [95% CI, −57.8 to −37.4];P =0.03). Nonobese and obese patients had significantly worse 1‐year survival compared with severely obese patients (63% versus 76% versus 95%, respectively;P &lt;0.01). Patients with normalNT ‐proBNP (13%) were younger, with higherBMI , less atrial fibrillation, and less structural heart disease than those with elevatedNT ‐proBNP.Conclusions In hospitalized patients withHF pEF ,NT ‐proBNP was inversely related toBMI with the largest decrease inNT ‐proBNP seen in the highest obesity category. These findings have implications for the role ofNT ‐proBNP in the diagnosis and assessment of treatment response in obese patients withHF pEF .

journal of the american heart association. cardiovascular and cerebrovascular disease

Highest Obesity Category Associated With Largest Decrease in N‐Terminal Pro‐B‐Type Natriuretic Peptide in Patients Hospitalized With Heart Failure With Preserved Ejection Fraction