What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Atrial Fibrillation without Heart Failure (n=239). Intervention: Overweight or obesity (BMI ≥ 25 kg/m2) vs. Normal weight (BMI < 25 kg/m2). Primary outcome: Plasma NT-proBNP levels (fmol/ml) (p=<0.05).

August 21, 2014PLoS ONEOpen Access

Impact of Body Mass Index on Plasma N-Terminal ProB-Type Natriuretic Peptides in Chinese Atrial Fibrillation Patients without Heart Failure

Q: What are the key findings of this study?

Overweight or obese patients with atrial fibrillation without heart failure had significantly lower median plasma NT-proBNP levels compared to normal weight patients (437 vs 501 fmol/ml).

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Key result

Overweight or obese patients with atrial fibrillation without heart failure had significantly lower median plasma NT-proBNP levels compared to normal weight patients (437 vs 501 fmol/ml).

Why the study?

Does higher BMI correlate with reduced NT-proBNP levels in atrial fibrillation patients without heart failure?

Study Design

Type

Cross-Sectional (n=239)

Multicenter

Structured PICO

Does higher BMI correlate with reduced NT-proBNP levels in atrial fibrillation patients without heart failure?

Population

239 Chinese patients (mean age 56, 25% female) with atrial fibrillation and preserved ejection fraction undergoing catheter ablation, evaluated cross-sectionally for NT-proBNP levels.

Exposure

Overweight or obese status (BMI ≥25 kg/m2)

Comparator

Normal weight status (BMI <25 kg/m2)

Outcome

Plasma N-terminal proB-type natriuretic peptide (NT-proBNP) levels measured prior to the ablation proceduresurrogate

Main Result

Absolute Event Rate: 437% vs 501%

p-value: p=<0.05

In Chinese patients with atrial fibrillation without heart failure, higher body mass index is independently associated with lower plasma NT-proBNP levels.

Limitations

Study included only Chinese populations, where average BMI is lower than in Western countries.
Low use of warfarin for stroke prevention among the study cohort.
Involved a selected population of patients referred for catheter ablation, which may limit generalizability to all AF patients.
Plasma NT-proBNP levels were measured in fmol/ml rather than the standard pg/ml.
Study included only Chinese populations, which may differ from Western populations
Low use of warfarin for stroke prevention among the AF patients
Population restricted to patients referred for catheter ablation, limiting extrapolation to the general AF population
NT-proBNP levels were measured in fmol/ml rather than the usual pg/ml

Implication

May warrant BMI consideration when interpreting NT-proBNP in AF without HF; leaves open need for adjusted cutoffs in prospective cohorts.

Abstract

BACKGROUND: An inverse relationship between body mass index (BMI) and circulating levels of N-terminal proB-type natriuretic peptide (NT-proBNP) has been demonstrated in subjects with and without heart failure. Obesity also has been linked with increased incidence of atrial fibrillation (AF), but its influence on NT-proBNP concentrations in AF patients remains unclear. This study aimed to investigate the effect of BMI on NT-proBNP levels in AF patients without heart failure. METHODS: A total of 239 consecutive patients with AF undergoing catheter ablation were evaluated. Levels of NT-proBNP and clinical characteristics were compared in overweight or obese (BMI≥25 kg/m2) and normal weight (BMI<25 kg/m2) patients. RESULTS: Of 239 patients, 129 (54%) were overweight or obese. Overweight or obese patients were younger, more likely to have a history of nonparoxysmal AF, hypertension, and diabetes mellitus. Levels of NT-proBNP were significantly lower in overweight or obese than in normal weight subjects (P<0.05). The relationship of obesity and decreased NT-proBNP levels persisted in subgroup of hypertension, both gender and both age levels (≥65 yrs and <65 yrs).Multivariate linear regression identified BMI as an independent negative correlate of LogNT-proBNP level. CONCLUSIONS: An inverse relationship between BMI and plasma NT-proBNP concentrations have been demonstrated in AF patients without heart failure. Overweight or obese patients with AF appear to have lower NT-proBNP levels than normal weight patients.

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Cite This Study

Zheng et al. (2014) conducted a cross-sectional in Atrial Fibrillation without Heart Failure (n=239). Overweight or obesity (BMI ≥ 25 kg/m2) vs. Normal weight (BMI < 25 kg/m2) was evaluated on Plasma NT-proBNP levels (fmol/ml) (p=<0.05). Overweight or obese patients with atrial fibrillation without heart failure had significantly lower median plasma NT-proBNP levels compared to normal weight patients (437 vs 501 fmol/ml).

synapsesocial.com/papers/6a99dffaf9da1bc1819e3561 https://doi.org/10.1371/journal.pone.0105249