CARDIOVASCULAR MEDICINE

B-type natriuretic peptide can detect silent myocardial ischaemia in asymptomatic type 2 diabetes

B S Rana¹, J I Davies¹, M M Band¹, S D Pringle², A Morris¹, A D Struthers¹

¹ Division of Medicine and Therapeutics, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
² Department of Cardiology, Ninewells Hospital and Medical School, Dundee, UK

Correspondence to:
Dr Justine Davies
Department of Clinical Pharmacology, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK; j.i.davies{at}dundee.ac.uk

Objective: To find out whether B-type natriuretic peptide (BNP) detects silent myocardial ischaemia in patients with type 2 diabetes, since many of these patients have silent ischaemia leading to unexpected cardiac deaths.

Design: Prospective cross-sectional study with consecutive recruitment of patients.

Setting: Outpatient, single centre.

Patients: 219 patients with type 2 diabetes. Patients were excluded if they had a history or evidence of cardiac failure.

Outcome measures: BNP, echocardiography and exercise tolerance test (ETT). BNP was compared with the ETT result in all patients and specifically in those who had no apparent ischaemic heart disease (IHD).

Results: 121 patients had no history of IHD or cardiac failure and of these patients 85 had a clearly abnormal or normal ETT result. BNP was higher in patients with an abnormal than with a normal ETT (mean 58.2 (SD 46.3) v 24.4 (SD 15.7) pg/ml, p < 0.001). In univariate analysis BNP was an independent predictor of an abnormal ETT (p < 0.001). In multivariate analysis BNP remained an independent predictor of the ETT result. BNP concentration over 20 pg/ml predicted an abnormal ETT result with a sensitivity of 87% and specificity of 37%, and BNP over 40 pg/ml had a sensitivity of 63% and a specificity of 81%.

Conclusion: BNP is of value in predicting silent ischaemia on exercise testing in asymptomatic patients with type 2 diabetes.

Abbreviations: ACIP, Asymptomatic Cardiac Ischemia Pilot; BNP, B-type natriuretic peptide; ETT, exercise tolerance testing; EUROASPIRE, European action on Secondary Prevention through Intervention to Reduce Events; IHD, ischaemic heart disease; IQR, interquartile range; LV, left ventricular; LVEF, left ventricular ejection fraction; LVMI, left ventricular mass index

Keywords: natriuretic peptides; myocardial ischaemia; exercise tolerance testing

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