[The impact of obesity on natriuretic peptide cut-off values for the diagnosis of heart failure].

Measurement of natriuretic peptides (BNP and NT-proBNP) has an important role in diagnosing heart failure. However, in patients with obesity, circulating levels of these peptides are consistently lower, yet current diagnostic cut-off values do not account for this. This article discusses the implications of obesity on natriuretic peptide interpretation, particularly in heart failure with preserved ejection fraction (HFpEF). Recent data show that the conventional rule-out threshold (<125 ng/L) lacks sensitivity in obese patients, potentially missing up to one-third of HFpEF cases. Lowering the cut-off in patients with obesity markedly improves diagnostic accuracy, while adjusted rule-in thresholds enhance specificity. These findings highlight the need for individualized interpretation of natriuretic peptide levels, incorporating body weight to avoid underdiagnosis of HFpEF in patients with obesity.