Article Text

Download PDFPDF
45 Role of Natriuretic Peptides in Screening of Cardiac Dysfunction in Older Patients with Type-2 Dibetes Mellitus. A Report from Sica-diabetes Study (FP7/2007–2013/241558)
  1. Helen Fazlalizadeh1,
  2. Pierpaolo Pellicori1,
  3. Syed Kazmi1,
  4. Jufen Zhang1,
  5. Andrew Clark1,
  6. Bokyi Saveliych2,
  7. John Warden1,
  8. T Byass2,
  9. C Henderson2,
  10. R Freeman2,
  11. John GF Cleland1
  1. 1Academic Cardiology/Castle Hill Hospital
  2. 2Hull and East Yorkshire Hospitals


Purpose Type-2 diabetes mellitus (T2DM) is risk factor for developing cardiac dysfunction and heart failure. The plasma concentration of amino-terminal pro-brain natriuretic peptide (NT-proBNP) could be a simple tool for screening for cardiac dysfunction amongst older patients with T2DM.

Method Patients receiving treatment for T2DM for at least 12 months, aged >40 years and not already known to have heart or renal failure were invited to complete a symptom questionnaire and to have NT-proBNP measuredas part of their annual check-up in primary care. Patients also had a physical examination, routine laboratory tests and were tested for neuropathy and retinopathy. All patients with increased NT-proBNP values and a sample of others was invited to attend for further cardiac investigations.

Results Of 1224 patients screened, the median age was 65 (IQR: 58–72) years and 520 (42%) were women. NT-proBNP was >500 ng/L in 54 (4%), 250–500 ng/L in 83 (7%), 125–250 ng/L in 212 (17%), 50–125 ng/L in 424 (34%) and <50ng/L in 451 (37%). Patients with higher NT-proBNP had lower body mass index, smaller waist circumference and higher serum creatinine but had similar heart rate and blood pressure. Of the 54 patients with values >500 ng/L, 43% had symptoms suggesting heart failure, and 20% had serum creatinine >150 umol/L (median: 100 (IQR: 81–140) µmol/L). In patients with NT-proBNP >500 ng/L, 2% had serum creatinine >150 umol/L (median: 77(65–91) µmol/L) and 19% had maculopathy or Grade 2 or worse retinopathy. Onechocardiography, all but two patients had major cardiac dysfunction; 24% had left ventricular ejection fraction <50%, 78% a dilated left atrium >38 mm, 30% had elevated systolic pulmonary artery pressures (>40 mmHg) and 42% patients were in atrial fibrillation. During a median follow-up of 436 (IQR: 334–503) days, the percentage of patients with a cardiovascular admission rose progressively from 8%, 13%, 19% to 28% and all-cause mortality from 0.6%, 0.6%, 1.2%, 3.9% to 9.8% for each of the NT-proBNP strata.

Conclusions NT-proBNP is a simple method of screening for cardiac dysfunction inT2DM. A high proportion of those with elevated values have a dilated left atrium and pulmonary hypertension possibly reflecting left ventricular diastolic dysfunction.

  • NT-proBNP
  • cardiac dysfunction
  • T2DM

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.