The influence of body mass index on clinical interpretation of established and novel biomarkers in acute heart failure

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Journal of cardiac failure


BACKGROUND: Body mass index (BMI) is a known confounder for natriuretic peptides but its influence on other biomarkers is less well described. We investigated whether BMI interacts with biomarkers association with prognosis in patients with acute heart failure (AHF).

METHODS AND RESULTS: B-type natriuretic peptide (BNP), high-sensitivity cardiac troponin I (hs-cTnI), galectin-3, serum neutrophil gelatinase associated lipocalin (sNGAL) and urine NGAL were measured serially in AHF patients during hospitalization in the AKINESIS study. Cox regression analysis was used to determine the association of biomarkers and their interaction with BMI for 30-day, 90-day and 1-year composite outcome of death or HF readmission. Among 866 patients, 21.2%, 29.7%, and 46.8% had normal (18.5-24.9 kg/m(2)), overweight (25-29.9 kg/m(2)), and obese (≥30 kg/m(2)) BMIs on admission, respectively. Admission values of BNP and hs-cTnI were negatively associated with BMI, while galectin-3 and sNGAL were positively associated with BMI. Admission BNP and hs-cTnI were associated with the composite outcome within 30-day, 90-day and 1-year. Only BNP had a significant interaction with BMI. When BNP was analyzed by BMI category, its association with the composite outcome attenuated at higher BMIs and was no longer significant in obese individuals. Findings were similar when evaluated by the last measured biomarkers and BMI.

CONCLUSIONS: In patients with AHF, only BNP had a significant interaction with BMI for the outcomes with its association attenuating as BMI increased. hs-cTnI was prognostic regardless of BMI.

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ePub ahead of print