title: NT-proBNP, echocardiographic abnormalities and subclinical coronary artery disease in high risk type 2 diabetic patients.
abstract: BACKGROUND
  Intensive multifactorial treatment aimed at prevention of cardiovascular (CV) disease may reduce left ventricular (LV) echocardiographic abnormalities in diabetic subjects. Plasma N-terminal (NT)-proBNP predicts CV mortality in diabetic patients but the association between P-NT-proBNP and the putative residual abnormalities in such patients are not well described. This study examined echocardiographic measurements of LV hypertrophy, atrial dilatation and LV dysfunction and their relation to P-NT-proBNP levels or subclinical coronary artery disease (CAD) in type 2 diabetic patients with microalbuminuria receiving intensive multifactorial treatment.
  
  
  METHODS
  Echocardiography including tissue Doppler imaging and P-NT-proBNP measurements were performed in 200 patients without prior CAD. Patients with P-NT-proBNP > 45.2 ng/L and/or coronary calcium score ≥ 400 were stratified as high risk patients for CAD(n = 133) and examined for significant CAD by myocardial perfusion imaging and/or CT-angiography and/or coronary angiography.
  
  
  RESULTS
  LV mass index was 41.2 ± 10.9 g/m2.7 and 48 (24%) patients had LV hypertrophy. LA and RA dilatation were found in 54(27%) and 45(23%) patients, respectively, and LV diastolic dysfunction was found in 109(55%) patients. Patients with increased P-NT-proBNP levels did not have more major echocardiographic abnormalities. In 70(53%) of 133 high risk patients significant CAD was demonstrated and patients with LV hypertrophy had increased risk of significant CAD(adjusted odd ratio[CI] was 4.53[1.14-18.06]).
  
  
  CONCLUSIONS
  Among asymptomatic type 2 diabetic patients with microalbuminuria that received intensive multifactorial treatment, P-NT-proBNP levels is not associated with echocardiographic abnormalities. LV diastolic dysfunction was frequently observed, whereas LV hypertrophy was less frequent but associated with significant CAD.
authors.affiliation: Steno Diabetes Center, Niels Steensenvej 1, DK-2820 Gentofte, Denmark. hrhl@dadlnet.dk
authors.forename: Henrik
authors.initials: H
authors.lastname: Reinhard
authors.forename: Peter R
authors.initials: PR
authors.lastname: Hansen
authors.forename: Niels
authors.initials: N
authors.lastname: Wiinberg
authors.forename: Andreas
authors.initials: A
authors.lastname: Kjær
authors.forename: Claus L
authors.initials: CL
authors.lastname: Petersen
authors.forename: Kaj
authors.initials: K
authors.lastname: Winther
authors.forename: Hans-Henrik
authors.initials: HH
authors.lastname: Parving
authors.forename: Peter
authors.initials: P
authors.lastname: Rossing
authors.forename: Peter K
authors.initials: PK
authors.lastname: Jacobsen
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000209:etiology; D058070:Asymptomatic Diseases; D015415:Biomarkers / Q000097:blood; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology*; D003430:Cross-Sectional Studies; D003718:Denmark; D048909:Diabetes Complications / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000628:therapy; D015150:Echocardiography, Doppler; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology*; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D055414:Myocardial Perfusion Imaging; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D016017:Odds Ratio; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology*
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain