Premium
N‐terminal pro‐B‐type natriuretic peptide: an independent marker for coronary artery disease in asymptomatic diabetic patients
Author(s) -
Cosson E.,
Nguyen M. T.,
Pham I.,
Pontet M.,
Nitenberg A.,
Valensi P.
Publication year - 2009
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/j.1464-5491.2009.02788.x
Subject(s) - medicine , cardiology , asymptomatic , coronary artery disease , natriuretic peptide , heart failure , odds ratio , ejection fraction , diabetes mellitus , body mass index , risk factor , endocrinology
Aims To determine whether plasma N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) levels, a marker for cardiac failure and potentially for the severity of coronary artery disease (CAD), predicts silent myocardial ischaemia (SMI) and silent CAD in asymptomatic high‐risk diabetic patients. Methods Five hundred and seventeen asymptomatic diabetic patients with ≥ 1 additional cardiovascular risk factor but without heart failure were prospectively screened between 1998 and 2008 for SMI, defined as an abnormal stress myocardial scintigraphy, and subsequently for significant (> 70%) angiographic CAD. The 323 patients with interpretable echocardiography and for whom NT‐proBNP was measured were included in this analysis. Results SMI was found in 108 (33.4%) patients, 39 of whom had CAD. NT‐proBNP was higher in the patients with CAD than in the patients without CAD [45.0 (1–3199) vs. 20.0 (1–1640) pg/ml; P < 0.0001 median (range)], even after adjustment for confounding factors: age, gender, body mass index, glycated haemoglobin (HbA 1c ), retinopathy, nephropathy, hypertension, echocardiographic parameters ( P < 0.05). NT‐proBNP in the third tertile (≥ 38 pg/ml) predicted CAD with a sensitivity of 59% and a specificity of 67%. In a multiple logistic regression analysis including NT‐proBNP ≥ 38 pg/ml, age, body mass index, gender, HbA 1c , hypertension, retinopathy, nephropathy, peripheral occlusive arterial disease, left ventricular systolic dysfunction, dilatation and hypertrophy and Type 1 transmitral flow, NT‐proBNP ≥ 38 pg/ml was the only significant independent predictor of silent CAD [odds ratio (OR) 3.1 (95% confidence interval 1.3–7.6), P = 0.015]. Conclusions NT‐proBNP measurement helps to better define asymptomatic diabetic patients with an increased likelihood for CAD, independently of cardiac function and structure.