Admission pro-B-type Natriuretic Peptide by Obesity Category in Hospitalized Heart Failure with Preserved Ejection Fraction

Abstract

Background Heart failure with preserved ejection fraction (HFpEF) constitutes half of HF hospitalizations today and is commonly associated with obesity. Levels of B-type natriuretic peptide (BNP or pro-BNP), a prognostic marker in HF, have been shown to inversely correlate with obesity, and are lower in HFpEF compared to HF with reduced EF patients. It is unclear, however, how obesity affects admission pro-BNP in HFpEF patients hospitalized with acute HF. Objective We sought to compare admission and % change in pro-BNP levels with diuresis across obesity categories in HFpEF patients hospitalized with acute HF. Methods We analyzed data from the Randomized Evaluation of Heart Failure with Preserved Ejection Fraction Patients with Acute Heart Failure and Dopamine (ROPA-DOP) study. Patients were stratified into 3 obesity categories by body mass index (BMI; non-obese: 2 ). Enrollment and discharge pro-BNP were compared with the Kruskal-Wallis test and multivariable linear regression was performed. Results The ROPA-DOP trial enrolled 90 HFpEF patients hospitalized for acute HF of which 88 (98%) and 71 (79%) had complete pro-BNP data at admission and discharge, respectively. The mean age of the cohort was 66 years (±13 years), 94% with hypertension, 59% with diabetes, and mean BMI of 40.8 kg/m 2 (±12.9 kg/m 2 ). Pro-BNP at enrollment and discharge were inversely correlated with BMI (p= 0.001, respectively; Table ). In multivariable linear regression, pro-BNP was lower in obese and morbidly obese groups compared to the non-obese group (p=0.008 and p Conclusions In an obese HFpEF population hospitalized with acute HF, we found that admission pro-BNP was elevated across all BMI groups, and was inversely associated with BMI. Those with morbid obesity (≥40 kg/m 2 ) had greater % decrease in pro-BNP with diuresis. Our results suggest that obesity category should be used to inform the interpretation of admission pro-BNP levels, and that % pro-BNP change may be an alternative marker of decongestion in obese HFpEF patients.