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B-type natriuretic peptide can detect silent myocardial ischaemia in asymptomatic type 2 diabetes
  1. B S Rana1,
  2. J I Davies1,
  3. M M Band1,
  4. S D Pringle2,
  5. A Morris1,
  6. A D Struthers1
  1. 1Division of Medicine and Therapeutics, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
  2. 2Department of Cardiology, Ninewells Hospital and Medical School, Dundee, UK
  1. 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

Abstract

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.

  • 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
  • natriuretic peptides
  • myocardial ischaemia
  • exercise tolerance testing

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Footnotes

  • Published Online First 9 December 2005

  • This research was funded by the Chief Scientist Office, Scottish Department of Health

  • Competing interests: None declared

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