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.
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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)