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- Title
N-terminal pro-B-type natriuretic peptide: an independent marker for coronary artery disease in asymptomatic diabetic patients.
- Authors
Cosson, E.; Nguyen, M. T.; Pham, I.; Pontet, M.; Nitenberg, A.; Valensi, P.
- Abstract
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 (HbA1c), 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, HbA1c, 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.
- Subjects
CORONARY disease; ATRIAL natriuretic peptides; LEFT heart ventricle; BODY mass index; ECHOCARDIOGRAPHY; LOGISTIC regression analysis; CLINICAL trials
- Publication
Diabetic Medicine, 2009, Vol 26, Issue 9, p872
- ISSN
0742-3071
- Publication type
Article
- DOI
10.1111/j.1464-5491.2009.02788.x