Nyckelord
Heart failure
Paradox
Mistaken identity
Abstract
Background: Obesity paradox is a clinical situation
where obesity confers benefit. This is anachronistic
considering that obesity increases the risk of
cardiovascular diseases like heart failure (HF). This
raises the question of whether obese patients with
clinically diagnosed HF were actually in HF.
Methods: This was a secondary analysis of data
generated in a larger study on Prevalence of
Dysnatraemia in HF patients admitted on our service.
History, physical and 2D echocardiographic
examinations were done for the study patients. Blood
was taken for point of care NT- pro BNP assay.
Echo and BNP data were divided along weight group
lines and compared
Results: There were 120 patients; 69 males and 51
females aged between 18 to 92 years with a mean
of 51.9 + 16.67 (SD) years. The NT-pro BNP levels
ranged from 301.0 to 950.0 pg/ml with a mean of
509.7 +_ 161.9 (SD) pg/ml. Applying the appropriate
age specific cut off values, 25/120 (20.8%) were
accurately identified as HF; while 95/120 (79.2%)
were misclassified. Of the 120, 13 were obese, 29
overweight and 78 normal. 11/13 of the obese
(84.6%) were misclassified. 22/29 overweight
(75.9%) were misclassified and 62/78 with normal
weight (79.5%) were misclassified. The proportion
misclassified was high across board but highest for
the obese category. Mean ejection fraction (EF) rose
significantly (p = 0.037) with BMI; more for males
(p=0.019) than females (p = 0.54). Using EF > 50%
to define heart failure with preserved ejection fraction
(HFpEF) BMI was higher in HFpEF compared with
HFrEF to a statistically significant level, p = 0 001
again more in males than females.
Conclusion: Using BNP as a marker of HF in the
obese gives inconsistent results; and should be
reserved for prognostication and follow- up. Most
obese people are likely to present with clinical
features of HF without actually being in HF.
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