HR: researched data, contributed to discussion, wrote manuscript. PKJ, PR, PRH, H-HP, NW, AK, CLP, KW: researched data, contributed to discussion, reviewed/edited manuscript. All authors read and approved the final manuscript.
Intensive multifactorial treatment aimed at prevention of cardiovascular (CV) disease may reduce left ventricular (LV) echocardiographic abnormalities in diabetic subjects. Plasma N-terminal (NT)-proBNP predicts CV mortality in diabetic patients but the association between P-NT-proBNP and the putative residual abnormalities in such patients are not well described. This study examined echocardiographic measurements of LV hypertrophy, atrial dilatation and LV dysfunction and their relation to P-NT-proBNP levels or subclinical coronary artery disease (CAD) in type 2 diabetic patients with microalbuminuria receiving intensive multifactorial treatment.
Echocardiography including tissue Doppler imaging and P-NT-proBNP measurements were performed in 200 patients without prior CAD. Patients with P-NT-proBNP > 45.2 ng/L and/or coronary calcium score ≥ 400 were stratified as high risk patients for CAD(n = 133) and examined for significant CAD by myocardial perfusion imaging and/or CT-angiography and/or coronary angiography.
LV mass index was 41.2 ± 10.9 g/m2.7 and 48 (24%) patients had LV hypertrophy. LA and RA dilatation were found in 54(27%) and 45(23%) patients, respectively, and LV diastolic dysfunction was found in 109(55%) patients. Patients with increased P-NT-proBNP levels did not have more major echocardiographic abnormalities. In 70(53%) of 133 high risk patients significant CAD was demonstrated and patients with LV hypertrophy had increased risk of significant CAD(adjusted odd ratio[CI] was 4.53[1.14-18.06]).
Among asymptomatic type 2 diabetic patients with microalbuminuria that received intensive multifactorial treatment, P-NT-proBNP levels is not associated with echocardiographic abnormalities. LV diastolic dysfunction was frequently observed, whereas LV hypertrophy was less frequent but associated with significant CAD.
Srivastava PM, Calafiore P, MacIsaac RJ: Prevalence and predictors of cardiac hypertrophy and dysfunction in patients with Type 2 diabetes. Clin Sci (Lond). 2008, 114 (4): 313-320. 10.1042/CS20070261. CrossRef
Reinhard H, Wiinberg N, Hansen PR: NT-proBNP levels, atherosclerosis and vascular function in asymptomatic type 2 diabetic patients with microalbuminuria: peripheral reactive hyperaemia index but not NT-proBNP is an independent predictor of coronary atherosclerosis. Cardiovasc Diabetol. 2011, 10: 71-10.1186/1475-2840-10-71. PubMedCentralCrossRefPubMed
Lang RM, Bierig M, Devereux RB: Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005, 18 (12): 1440-1463. 10.1016/j.echo.2005.10.005. CrossRefPubMed
Palmieri V, de SG, Arnett DK: Relation of various degrees of body mass index in patients with systemic hypertension to left ventricular mass, cardiac output, and peripheral resistance (The Hypertension Genetic Epidemiology Network Study). Am J Cardiol. 2001, 88 (10): 1163-1168. 10.1016/S0002-9149(01)02054-9. CrossRefPubMed
Langenickel T, Pagel I, Hohnel K: Differential regulation of cardiac ANP and BNP mRNA in different stages of experimental heart failure. Am J Physiol Heart Circ Physiol. 2000, 278 (5): H1500-H1506. PubMed
Paulus WJ, Tschope C, Sanderson JE: How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology. Eur Heart J. 2007, 28 (20): 2539-2550. 10.1093/eurheartj/ehm037. CrossRefPubMed
Christensen LL, Anker-Nielsen A, Almdal TP: Development in Quality of Treatment in Complicated Type 2 Diabetes Assessed by the Proportion of Patients Reaching ADA Goals. Diabetes. 2010, 59: A180-A181.
Okin PM, Devereux RB, Gerdts E: Impact of diabetes mellitus on regression of electrocardiographic left ventricular hypertrophy and the prediction of outcome during antihypertensive therapy: the Losartan Intervention For Endpoint (LIFE) Reduction in Hypertension Study. Circulation. 2006, 113 (12): 1588-1596. 10.1161/CIRCULATIONAHA.105.574822. CrossRefPubMed
- NT-proBNP, echocardiographic abnormalities and subclinical coronary artery disease in high risk type 2 diabetic patients
Peter R Hansen
Claus L Petersen
Peter K Jacobsen
- BioMed Central
Neu im Fachgebiet Innere Medizin
Meistgelesene Bücher aus der Inneren Medizin
Mail Icon II