title: Early diagnosis of left ventricular diastolic dysfunction in diabetic patients: a possible role for natriuretic peptides.
abstract: BACKGROUND
  The aim of the present study was to verify whether BNP might detect pre-clinical diastolic dysfunction (LVDD) in type-2 diabetic patients.
  
  
  METHODS
  One-hundred and twenty-seven consecutive outpatients with type-2 diabetes mellitus were enrolled into the study. Subjects with overt heart failure or NYHA class > 1, history of coronary artery disease, severe valvulopathy or chronic atrial fibrillation were excluded from the study. All patients underwent clinical evaluation, laboratory assessment of brain natriuretic peptide (BNP) and echocardiographic examination.
  
  
  RESULTS
  No patients showed systolic impairment of left ventricular function, whereas diastolic dysfunction was detected in 53 (42%) cases (all impaired relaxation). Median BNP was 27 pg/ml without any significant difference between 76 patients with normal left ventricular function and 53 with diastolic dysfunction; in 54 (43%) patients showing HBA1C≥8 (uncontrolled diabetes) normal function was found in 32 and diastolic dysfunction in 22, with a significant difference of BNP at multivariate analysis (OR = 1.02, 95%CI = 1.05-1.09, p = 0.003). In uncontrolled diabetic cohort, BNP was a strong predictor for LVDD (OR = 2.7, 95%CI = 1.3-5.6, p = 0.006) along with the duration of diabetes (OR = 1.6, 95%CI = 1.1-2.9, p = 0.046). BNP > 25 pg/ml was a cut-off value with high accuracy to detect a LVDD.
  
  
  CONCLUSIONS
  Early screening of high-risk patients for diabetic cardiomyopathy development might be useful to better control glycemic profile in order to reduce heart disease progression or even to reverse it
  
  
  CONCLUSIONS
  BNP could be a cheap, easy and useful tool to screen those ones with preclinical ventricular diastolic dysfunction in a subset of patients particularly prone to develop cardiovascular complications, like uncontrolled diabetic patients.
authors.affiliation: Cardiology, Department of Internal Medicine and Public Health, University of L'Aquila, Italy. silvio.romano@cc.univaq.it
authors.forename: Silvio
authors.initials: S
authors.lastname: Romano
authors.forename: Michele
authors.initials: M
authors.lastname: Di Mauro
authors.forename: Simona
authors.initials: S
authors.lastname: Fratini
authors.forename: Leonello
authors.initials: L
authors.lastname: Guarracini
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Guarracini
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Poccia
authors.forename: Maria
authors.initials: M
authors.lastname: Penco
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D048909:Diabetes Complications / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D003971:Diastole; D042241:Early Diagnosis; D018618:Echocardiography, Doppler, Color; D018619:Echocardiography, Doppler, Pulsed; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007558:Italy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D016017:Odds Ratio; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers; D006442:Glycated Hemoglobin; D020097:Natriuretic Peptide, Brain; C517652:hemoglobin A1c protein, human