Prognostic role of B-type natriuretic peptide in patients with diabetes and acute decompensated heart failure.
BACKGROUND
Several studies have reported the prognostic value of natriuretic peptides, but their predictive value in patients with diabetes mellitus is unknown. The aim of the study was to test the hypothesis that measurement of brain natriuretic peptide (BNP) levels in ambulatory patients with congestive heart failure (CHF) and diabetes can predict the occurrence of cardiovascular events at 6-month follow-up.


METHODS
We enrolled 145 consecutive patient with diabetes [age 72 +/- 9 years, hypertension (21%), ischaemic heart disease (52%), atrial fibrillation (22%), preserved left ventricular function (29%)] seen in the outpatient heart failure clinic after an acute episode of cardiac failure.


RESULTS
The median (25th/75th interquartile range) BNP concentrations at discharge were 186 (75-348) pg/ml. At 6-month clinical follow-up 10/145 (7%) subjects had died and 31/145 (21%) had been readmitted because of cardiac decompensation. BNP values of 200 and 500 pg/ml were found to have the best compromise between sensitivity (88 and 46%, respectively) and specificity (71 and 89%, respectively) for predicting events at 6 months. Multivariate Cox regression analysis identified only two parameters as predictors of events: serum creatinine [hazard ratio (HR) = 3.3; P = 0.02], and BNP plasma level BNP cut-off values (HR = 3.8; P = 0.03 for 201-499 pg/ml and HR = 7.7; P = 0.001 for > or = 500 pg/ml).


CONCLUSIONS
These results suggest that BNP and serum creatinine are strong predictors of clinical events in patients with diabetes and CHF. In these patients, clinical outcome might be stratified by plasma BNP levels.
Aspromonte
N
N
Heart Failure Unit, Department of Cardiology, Ospedale S Croce-Carle, Cuneo, Italy. naspromonte@yahoo.it
Feola
M
M
Milli
M
M
Scardovi
A B
AB
Coletta
C
C
Carbonieri
E
E
Giovinazzo
P
P
Di Giacomo
T
T
Barro
S
S
Rosso
G L
GL
Ceci
V
V
Milani
L
L
Valle
R
R
D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D003925:Diabetic Angiopathies / Q000175:diagnosis*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000378:metabolism*; D011379:Prognosis; D012680:Sensitivity and Specificity
D020097:Natriuretic Peptide, Brain