A lower NT-proBNP rule-out threshold of 150 ng/L in patients with BMI ≥30 kg/m² maintained high sensitivity (96%) and NPV (92%) for heart failure diagnosis (AUC 0.87; 95% CI 0.85-0.89).
Observational (n=2,384)
Yes
Does a lower NT-proBNP rule-out threshold of 150 ng/L improve diagnostic performance for heart failure in obese patients (BMI ≥30 kg/m²)?
A lower NT-proBNP rule-out threshold of 150 ng/L improves diagnostic sensitivity and negative predictive value for heart failure in patients with obesity.
Effect estimate: AUC 0.87 (95% CI 0.85-0.89)
Absolute Event Rate: 96% vs 96%
Abstract Background Obesity is associated with lower NT-proBNP levels, potentially reducing its sensitivity for heart failure (HF) diagnosis. Purpose This study evaluates the effect of body mass index (BMI) on NT-proBNP-based HF diagnosis and explores an optimized rule-out threshold for patients with elevated BMI. Methods The PRECISE-HF study prospectively enrolled emergency department (ED) patients across 17 U.S. sites. NT-proBNP concentrations were measured using a novel automated assay. Diagnostic performance was assessed in obese patients, defined as a BMI ≥30 kg/m², and an alternative rule-out cut point of 150 ng/L (rather than 300 ng/L) was evaluated. MACE (major adverse events; defined as death, myocardial infarction, or stroke) were evaluated at 90 days. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and AUC were analyzed. Results Of 2,384 patients meeting enrollment criteria, 91% of those with adjudicated HF, and NT-proBNP values 300 ng/L, had a BMI ≥30 kg/m². Lowering the rule-out cut point to 150 ng/L in the obese subgroup maintained high sensitivity (96%) and NPV (92%), vs. the 300 ng/L threshold of the overall population sensitivity (96%) and NPV (95%) with overlapping confidence intervals to support maintained diagnostic performance. AUC for HF diagnosis in patients with elevated BMI remained robust at 0.87 (95% CI: 0.85–0.89). Conclusions A lower NT-proBNP rule-out threshold of 150 ng/L improves sensitivity and NPV in patients with BMI ≥30 kg/m², efficiently addressing the known inverse relationship between obesity and natriuretic peptide levels. These findings support BMI-adjusted cut points for enhanced diagnostic accuracy in obese patients presenting with suspected HF.Lower cutpoint performance in Obesity
Allen et al. (Sat,) conducted a observational in Heart failure (n=2,384). NT-proBNP rule-out threshold of 150 ng/L vs. NT-proBNP rule-out threshold of 300 ng/L was evaluated on Diagnostic performance (sensitivity and NPV) for heart failure (AUC 0.87, 95% CI 0.85-0.89). A lower NT-proBNP rule-out threshold of 150 ng/L in patients with BMI ≥30 kg/m² maintained high sensitivity (96%) and NPV (92%) for heart failure diagnosis (AUC 0.87; 95% CI 0.85-0.89).