Open AccessLow NT‐proBNP levels in overweight and obese patients do not rule out a diagnosis of heart failure with preserved ejection fraction
Author(s) -
Buckley Leo F.,
Canada Justin M.,
Del Buono Marco G.,
Carbone Salvatore,
Trankle Cory R.,
Billingsley Hayley,
Kadariya Dinesh,
Arena Ross,
Van Tassell Benjamin W.,
Abbate Antonio
Publication year - 2018
Publication title -
esc heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.787
H-Index - 25
ISSN - 2055-5822
DOI - 10.1002/ehf2.12235
Subject(s) - medicine , ejection fraction , cardiology , heart failure , heart failure with preserved ejection fraction , natriuretic peptide , overweight , diastole , cardiorespiratory fitness , body mass index , blood pressure
Background Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome that presents clinicians with a diagnostic challenge. The use of natriuretic peptides to exclude a diagnosis of HFpEF has been proposed. We sought to compare HFpEF patients with N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) level above and below the proposed cut‐off. Methods Stable patients ( n = 30) with left ventricular (LV) ejection fraction ≥ 50% were eligible if they had a diagnosis of HF according to the European Society of Cardiology diagnostic criteria. Characteristics of patients with NT‐proBNP below (≤125 pg/mL) and above (>125 pg/mL) the diagnostic criterion were compared. Results There were 19 (66%) women with median age 54 years. Half were African American (16, 53%), and most were obese. There were no significant differences in clinical characteristics or medication use between groups. LV end‐diastolic volume index was greater in high NT‐proBNP patients ( P = 0.03). Left atrial volume index, E/e′ ratio, and E/e′ ratio at peak exercise were not significantly different between NT‐proBNP groups. Peak oxygen consumption (VO 2 ), VO 2 at ventilatory threshold, and ventilatory efficiency measures were impaired in all patients and were not significantly different between high and low NT‐proBNP patients. Conclusions NT‐proBNP was below the proposed diagnostic cut‐off point of 125 pg/mL in half of this obese study cohort. Cardiac diastolic dysfunction and cardiorespiratory fitness were not significantly different between high and low NT‐proBNP patients. These data indicate that excluding the diagnosis of HFpEF based solely on NT‐proBNP levels should be discouraged.