title: Utility of B-type natriuretic peptide (BNP) as a screen for left ventricular dysfunction in patients with diabetes.
abstract: OBJECTIVE
  Routine screening of diabetic patients with echocardiography is not feasible due to its limited availability and high cost. B-type natriuretic peptide (BNP) is secreted from the left ventricle in response to pressure overload and is elevated in both systolic and diastolic dysfunction.
  
  
  METHODS
  BNP levels were compared to echocardiographic findings in 263 patients. Patients were divided into two groups: clinical indication for echocardiography (CIE) (n = 172) and those without clinical indication for echocardiography (no-CIE) (n = 91). Cardiologists making the assessment of left ventricular function were blinded when measuring plasma levels of BNP.
  
  
  RESULTS
  The 91 patients with no-CIE with echoes had similar BNP levels (83 +/- 16 pg/ml) to the 215 patients with no-CIE without echoes (63 +/- 10, P = 0.10). Patients with CIE and subsequent abnormal left ventricular function (n = 112) had a mean BNP concentration of 435 +/- 41 pg/ml, compared with those with no-CIE, but had abnormal left ventricular function on echo (n = 32) (161 +/- 40 pg/ml). Twenty-one of 32 patients with no-CIE but with abnormal left ventricular function had diastolic dysfunction (BNP 190 +/- 60 pg/ml). A receiver-operating characteristic (ROC) curve revealed that the area under the curve was 0.91 for CIE patients and 0.81 for no-CIE patients (P < 0.001). For those with no congestive heart failure (CHF) symptoms, BNP levels showed a high negative predictive value (91% for BNP values <39 pg/ml), while in those patients who had a CIE, BNP levels showed a high positive predictive value for the detection of left ventricular dysfunction (96% with BNP levels >90 pg/ml).
  
  
  CONCLUSIONS
  BNP can reliably screen diabetic patients for the presence or absence of left ventricular dysfunction.
authors.affiliation: Department of Medicine, Veteran's Affairs Medical Center, San Diego, California 92161, USA.
authors.forename: Victoria
authors.initials: V
authors.lastname: Epshteyn
authors.forename: Katherine
authors.initials: K
authors.lastname: Morrison
authors.forename: Padma
authors.initials: P
authors.lastname: Krishnaswamy
authors.forename: Radmila
authors.initials: R
authors.lastname: Kazanegra
authors.forename: Paul
authors.initials: P
authors.lastname: Clopton
authors.forename: Sunder
authors.initials: S
authors.lastname: Mudaliar
authors.forename: Steven
authors.initials: S
authors.lastname: Edelman
authors.forename: Robert
authors.initials: R
authors.lastname: Henry
authors.forename: Alan
authors.initials: A
authors.lastname: Maisel
mesh_terms: D001281:Atrial Fibrillation / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D003327:Coronary Disease / Q000453:epidemiology; D003922:Diabetes Mellitus, Type 1 / Q000097:blood*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood*; D003925:Diabetic Angiopathies / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging; D003928:Diabetic Nephropathies / Q000453:epidemiology; D004452:Echocardiography; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging; D016277:Ventricular Function, Left / Q000502:physiology
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain