B-type Natriuretic Peptide can detect silent myocardial ischaemia in asymptomatic type II diabetic patients

Bushra S Rana ¹, Justine I Davies ^2*, Margaret M Band ¹, Stuart Pringle ¹, Andrew D Morris ¹ and Allan D D Struthers ³

¹ Dundee University, United Kingdom
² Ninewells Hospital & Medical School, United Kingdom
³ University of Dundee, United Kingdom

^* To whom correspondence should be addressed. E-mail: j.i.davies{at}dundee.ac.uk.

Accepted 17 November 2005

Abstract

Objective: B-Type Natriuretic Peptide (BNP) has been shown to predict future cardiovascular events independent of left ventricular function. This is partly because BNP has now been shown to detect silent myocardial ischaemia in suspected cases of angina pectoris. Our aim was therefore to find out if BNP detects silent myocardial ischaemia in patients with type 2 diabetes, since these subjects have a high frequency of 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 history or evidence of cardiac failure.

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

Results: 121 subjects had no prior history of IHD or cardiac failure and of these patients 85 had a clearly positive or negative ETT result. BNP was higher in those with a positive compared to a negative ETT (p<0.001). In univariate analysis BNP was an independent predictor of a positive ETT (p<0.001). In multivariate analysis BNP remained an independent predictor of the ETT result. A BNP result over 20pg/ml detected a positive ETT result with a sensitivity of 87% and specificity of 37%, while a BNP result over 40pg/ml had a sensitivity of 63% but a specificity of 81%.

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

Keywords: exercise tolerance testing, myocardial ischaemia, natriuretic peptides

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