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

PLOS ONE, Dec 2019

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

et al. (2014) Impact of Body Mass Index on Plasma N-Terminal ProB-Type Natriuretic Peptides in Chinese Atrial Fibrillation Patients without Heart Failure. PLoS ONE 9(8): e105249. doi:10.1371/journal.pone.0105249 Impact of Body Mass Index on Plasma N-Terminal ProB- Type Natriuretic Peptides in Chinese Atrial Fibrillation Patients without Heart Failure Li-hui Zheng 0 Ling-min Wu 0 Yan Yao 0 Wen-sheng Chen 0 Jing-ru Bao 0 Wen Huang 0 Rui Shi 0 Kui-jun Zhang 0 Shu Zhang 0 Marta Letizia Hribal, University of Catanzaro Magna Graecia, Italy 0 State Key Laboratory of Cardiovascular Disease, Clinical EP Lab & Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China 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. 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. - B-type natriuretic peptide (BNP) is synthesized as preproBNP in response to the stretch and pressure overload of the cardiac myocyte. After enzymatic cleavage, it is released into the circulation system in equimolar proportions as the hormonally active BNP and the inactive N-terminal fragment (N-terminal-proB-type natriuretic peptide, NT-proBNP).The expression of NTproBNP is affected by several variations, such as age, gender, hypertension, renal function and thyroid function [1]. Several recent reports suggest that obesity, as indexed by elevated body mass index (BMI), may also affect NT-proBNP levels, with lower circulating levels in those with higher BMI in subjects with acute or chronic heart failure [2,3], significant coronary artery disease or acute myocardial infarction [4,5] and healthy general populations [6]. However, isolated study showed that obesity is not statistically associated with NT-proBNP in asymptomatic patients with hypertension [7]. Atrial fibrillation (AF) is the most common cardiac arrhythmia in the clinical practice. NT-proBNP levels are increased in AF [8], and have proven their potential utility in the risk stratification, prognostication, and therapeutic decision-making in AF [911]. However, the effect of obesity on NT-proBNP in AF patients has yet to be clarified. We aimed to explore this relationship in the present study. Because AF has been linked with congestive heart failure, we hypothesized that a similar relationship might exist in AF. Patients Two hundred and thirty-nine consecutive patients with AF undergoing radiofrequency catheter ablation in our institution between January 2007 and January 2009 were included in this study. Exclusion criteria included chronic heart failure or left ventricular ejection fraction (LVEF) #50%, cardiomyopathy, valvular heart disease, hepatic or renal failure, acute coronary Normal weight: BMI,25 kg/m2 (n = 110) Serum creatinine (umol/L) Systolic blood pressure (mmHg) Diastolic blood pressure (mmHg) CHD = Coronary heart disease; LAD = Left atrial diameter; LVEDD = Left ventricular end diastolic diameter; LVEF = Left ventricular ejection fraction; ACEI = Angiotensinconverting enzyme inhibitor; ARB = Angiotensin receptor blocker; CCB = Calcium channel blocker; NT-proBNP = N-terminal proB-type natriuretic peptide; NS = No significant. doi:10.1371/journal.pone.0105249.t001 syndrome, acute pulmonary embolism, chronic obstructive pulmonary disease, rheumatic heart disease, and thyroid dysfunction. Informed written consent was obtained from all patients, and this study was approved by the Ethics Committee of Fuwai Hospital and clinical investigations are conducted according to the principles expressed in the Declaration of Helsinki. Clinical characteristics Patients were interviewed and records were reviewed to determine past medical history, medications, and pertinent laboratory values. Left atrial diamete (...truncated)


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Li-hui Zheng, Ling-min Wu, Yan Yao, Wen-sheng Chen, Jing-ru Bao, Wen Huang, Rui Shi, Kui-jun Zhang, Shu Zhang. Impact of Body Mass Index on Plasma N-Terminal ProB-Type Natriuretic Peptides in Chinese Atrial Fibrillation Patients without Heart Failure, PLOS ONE, 2014, 8, DOI: 10.1371/journal.pone.0105249