N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) for predicting silent myocardial ischaemia in type 2 diabetes mellitus independent of microalbuminuria
✍ Scribed by Kumiko Hamano; Mariko Abe; Rieko Komi; Shuzo Kobayashi
- Publisher
- John Wiley and Sons
- Year
- 2010
- Tongue
- English
- Weight
- 102 KB
- Volume
- 26
- Category
- Article
- ISSN
- 1520-7552
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✦ Synopsis
Abstract
Background
In the early identification of cardiovascular risk, it is essential to establish a biological marker for cardiac complications that is comparable to albuminuria for nephropathy. We tested the hypothesis that N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) might be a marker for silent myocardial ischaemia in diabetes.
Methods
In forty consecutively recruited subjects without evident coronary artery disease, serum NT‐proBNP was measured together with multi‐slice computed tomography. With patients suspected of having significant coronary artery stenosis by multi‐slice computed tomography, coronary angiography was performed. Silent myocardial ischaemia was defined as the presence of significant coronary artery stenosis with more than 50% luminal narrowing by angiography.
Results
Thirteen patients (32.5%) had silent myocardial ischaemia. NT‐proBNP levels were significantly higher in these patients (181.1 ± 43.8 versus 55.2 ± 9.7 pg/mL, p < 0.005) but HbA~1c~, lipid profiles, and creatinine were similar in the two groups. Moreover, log NT‐proBNP was identified as an independent predictor of silent myocardial ischaemia (R^2^ = 0.502, p < 0.05) after adjustment for HbA~1c~, creatinine, albuminuria, hypertension, hyperlipidaemia, or smoking. After stratifying patients by NT‐proBNP, the upper tertile compared to the lowest tertile was significantly associated with silent myocardial ischaemia (odds ratio: 26.7, p < 0.05). Receiver operation characteristics analysis with a cut‐off value of 52 pg/mL showed 92% sensitivity and 75% specificity for predicting silent myocardial ischaemia (positive predictive value 64.7%, negative predictive value 94.3%).
Conclusions
The outstandingly high negative predictive value of NT‐proBNP enables us to focus on diabetic patients with occult coronary disease, independently of microalbuminuria. Copyright © 2010 John Wiley & Sons, Ltd.