{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T16:28:11Z","timestamp":1789662491816,"version":"4.0.1"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2022,8,8]],"date-time":"2022-08-08T00:00:00Z","timestamp":1659916800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100001316","name":"Abbott Laboratories","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100001316","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007818","name":"Alere","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007818","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004337","name":"Roche","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004337","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004362","name":"Schweizerische Herzstiftung","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004362","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100016946","name":"Singulex","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100016946","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100016015","name":"Universit\u00e4tsspital Basel","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100016015","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008375","name":"Universit\u00e4t Basel","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008375","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["European J of Heart Fail"],"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Obese patients have lower natriuretic peptide concentrations. We hypothesized that adjusting the concentration of N\u2010terminal pro\u2010B\u2010type natriuretic peptide (NT\u2010proBNP) for obesity could further increase its clinical utility in the early diagnosis of acute heart failure (AHF).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>\n                      This hypothesis was tested in a prospective diagnostic study enrolling unselected patients presenting to the emergency department with acute dyspnoea. Two independent cardiologists\/internists centrally adjudicated the final diagnosis using all individual patient information including cardiac imaging. NT\u2010proBNP plasma concentrations were applied: first, using currently recommended cut\u2010offs; second, using cut\u2010offs lowered by 33% with body mass index (BMI) of 30\u201334.9 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      and by 50% with BMI \u2265\u200935\u2009kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      . Among 2038 patients, 509 (25%) were obese, of which 271 (53%) had AHF. The diagnostic accuracy of NT\u2010proBNP as quantified by the area under the receiver\u2010operating characteristic curve was lower in obese versus non\u2010obese patients (0.890 vs. 0.938). For rapid AHF rule\u2010out in obese patients, the currently recommended cut\u2010off of 300\u2009pg\/ml achieved a sensitivity of 96.7% (95% confidence interval [CI] 93.8\u201398.2%), ruling out 29% of patients and missing 9 AHF patients. For rapid AHF rule\u2010in, the age\u2010dependent cut\u2010off concentrations (age &lt;50\u2009years: 450\u2009pg\/ml; age 50\u201375\u2009years: 900\u2009pg\/ml; age &gt;75\u2009years: 1800\u2009pg\/ml) achieved a specificity of 84.9% (95% CI 79.8\u201388.9%). Proportionally lowering the currently recommended cut\u2010offs by BMI increased sensitivity to 98.2% (95% CI 95.8\u201399.2%), missing 5 AHF patients; reduced the proportion of AHF patients remaining in the \u2018gray zone\u2019 (48% vs. 26%;\n                      <jats:italic>p<\/jats:italic>\n                      = 0.002), achieving a specificity of 76.5% (95% CI 70.7\u201381.4%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Adjusting NT\u2010proBNP concentrations for obesity seems to further increase its clinical utility in the early diagnosis of AHF.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ejhf.2618","type":"journal-article","created":{"date-parts":[[2022,7,19]],"date-time":"2022-07-19T02:48:15Z","timestamp":1658198895000},"page":"1545-1554","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":40,"title":["Clinical effect of obesity on N\u2010terminal pro\u2010B\u2010type natriuretic peptide cut\u2010off concentrations for the diagnosis of acute heart failure"],"prefix":"10.1093","volume":"24","author":[{"given":"Nikola","family":"Kozhuharov","sequence":"first","affiliation":[{"name":"Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel University of Basel  Basel Switzerland"},{"name":"Department of Cardiology Liverpool Heart and Chest Hospital  Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jasmin","family":"Martin","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Cardiovascular 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