title: Influence of diabetes on natriuretic peptide thresholds in screening for Stage B heart failure.
abstract: BACKGROUND
  Natriuretic peptide (NP) has been shown to be an effective screening tool to identify patients with Stage B heart failure and to have clinical value in preventing heart failure progression. The impact of associated metabolic confounders on the screening utility of NP needs clarification.
  
  
  OBJECTIVE
  To assess the impact of diabetes mellitus (DM) on NP screening for asymptomatic Stage B heart failure.
  
  
  METHODS
  The study population consisted of 1368 asymptomatic patients with cardiovascular risk factors recruited from general practice as part of the STOP-HF trial. B-type NP (BNP) was quantified at point-of-care.
  
  
  RESULTS
  BNP was found to be as accurate for detecting Stage B heart failure in DM patients compared to non-DM patients (AUC 0.75 [0.71,0.78] and 0.77 [0.72,0.82], respectively). However, different BNP thresholds are required to achieve the same level of diagnostic sensitivity in DM compared with non-DM patients. To achieve 80% sensitivity a difference of 5-ng/L lower is required for patients with DM.
  
  
  CONCLUSIONS
  Although a significantly different BNP threshold is detected for patients with DM, the BNP concentration difference is small and unlikely to warrant a clinically different diagnostic threshold.
authors.affiliation: a Wellcome-Wolfson Building, Centre for Experimental Medicine , Queen's University Belfast , Belfast , Northern Ireland ;|b Chronic Cardiovascular Disease Management Group , St Vincent's University Hospital Healthcare Group , Dublin , Ireland ;
authors.forename: Chris
authors.initials: C
authors.lastname: Watson
authors.affiliation: b Chronic Cardiovascular Disease Management Group , St Vincent's University Hospital Healthcare Group , Dublin , Ireland ;
authors.forename: Stephanie
authors.initials: S
authors.lastname: James
authors.affiliation: b Chronic Cardiovascular Disease Management Group , St Vincent's University Hospital Healthcare Group , Dublin , Ireland ;
authors.forename: Eoin
authors.initials: E
authors.lastname: O'Connell
authors.affiliation: b Chronic Cardiovascular Disease Management Group , St Vincent's University Hospital Healthcare Group , Dublin , Ireland ;
authors.forename: Joe
authors.initials: J
authors.lastname: Gallagher
authors.affiliation: c School of Medicine , University College Dublin , Belfield, Dublin , Ireland ;
authors.forename: James
authors.initials: J
authors.lastname: O'Reilly
authors.affiliation: b Chronic Cardiovascular Disease Management Group , St Vincent's University Hospital Healthcare Group , Dublin , Ireland ;
authors.forename: Elaine
authors.initials: E
authors.lastname: Tallon
authors.affiliation: c School of Medicine , University College Dublin , Belfield, Dublin , Ireland ;
authors.forename: John
authors.initials: J
authors.lastname: Baugh
authors.affiliation: d Department of Endocrinology , St Vincent's University Hospital Healthcare Group , Elm Park, Dublin , Ireland.
authors.forename: Jean
authors.initials: J
authors.lastname: O'Connell
authors.affiliation: d Department of Endocrinology , St Vincent's University Hospital Healthcare Group , Elm Park, Dublin , Ireland.
authors.forename: Donal
authors.initials: D
authors.lastname: O'Shea
authors.affiliation: b Chronic Cardiovascular Disease Management Group , St Vincent's University Hospital Healthcare Group , Dublin , Ireland ;
authors.forename: Mark
authors.initials: M
authors.lastname: Ledwidge
authors.affiliation: b Chronic Cardiovascular Disease Management Group , St Vincent's University Hospital Healthcare Group , Dublin , Ireland ;|c School of Medicine , University College Dublin , Belfield, Dublin , Ireland ;
authors.forename: Ken
authors.initials: K
authors.lastname: McDonald
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood*; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D012372:ROC Curve; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain
keywords: B-type natriuretic peptide; cardiac biomarker; cardiovascular disease; diabetes mellitus; ventricular dysfunction