Beyond Heart Failure: Role of NT-Pro-BNP in Diabetes Mellitus Patients with Preserved Ejection Fraction.

Abstract

Background: Despite advancements in medical care, including coronary interventions and medications, cardiovascular-related mortality and morbidity remain disproportionately high among patients with diabetes mellitus. A significant factor contributing to this issue is the presence of asymptomatic macrovascular and microvascular angiopathies in many diabetic patients. These vascular complications are often detected at later stages, resulting in the failure of treatment strategies to effectively prevent the progression of heart failure and mitigate worsening conditions. Given this background, our research aims to explore the potential of the biochemical marker NT-pro-BNP (N-terminal pro b-type natriuretic peptide) in the early detection of left ventricular diastolic dysfunction in diabetic patients who maintain a preserved ejection fraction. Left ventricular diastolic dysfunction is a condition where the left ventricle has difficulty relaxing and filling with blood, which can precede the development of heart failure. Identifying this dysfunction early could be crucial in preventing major adverse cardiac events (MACE) such as heart attacks, stroke, and cardiovascular-related death. The focus of our study is to determine whether NT-pro-BNP, which is typically elevated in heart failure, can serve as an early marker for diastolic dysfunction in this specific patient population. By identifying diabetic patients at risk earlier, interventions could be tailored more effectively, potentially improving outcomes and reducing the incidence of severe cardiovascular events.

Study population and methods: This study was conducted at a tertiary care medical care hospital in Madurai, Tamil Nadu, India, with a sample population of 500 patients who had preserved ejection fraction. The participants were divided into two groups: 169 diabetic patients and 150 non-diabetic patients. As part of the baseline assessment, routine clinical chemistry analysis and 2D echocardiograms were performed. Additionally, the biomarker NT-pro-BNP, which is associated with heart failure, was measured using the electrochemiluminescence method.

Result: Among the diabetes and non-diabetes groups, the biomarker NT-pro-BNP were significantly different and the serum concentration of NT-pro-BNP was found to be higher in poor glycemic control type 2 diabetes mellitus patients. Serum NT-pro-BNP screening and 2D echocardiogram showed the best predictor of left ventricular diastolic dysfunction and hospital stay due to major adverse cardiac events in type 2 diabetes mellitus patients.

Conclusion: Our study highlights the clinical significance of NT-pro-BNP among (left ventricular diastolic dysfunction) type 2 diabetes mellitus with preserved ejection fraction > 60 %.