Document Detail

N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) for predicting silent myocardial ischaemia in type 2 diabetes mellitus independent of microalbuminuria.
MedLine Citation:
PMID:  20812386     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: In the early identification of cardiovascular risk, it is essential to establish a biological marker for cardiac complications that is comparable to albuminuria for nephropathy. We tested the hypothesis that N-terminal pro-brain natriuretic peptide (NT-proBNP) might be a marker for silent myocardial ischaemia in diabetes.
METHODS: In forty consecutively recruited subjects without evident coronary artery disease, serum NT-proBNP was measured together with multi-slice computed tomography. With patients suspected of having significant coronary artery stenosis by multi-slice computed tomography, coronary angiography was performed. Silent myocardial ischaemia was defined as the presence of significant coronary artery stenosis with more than 50% luminal narrowing by angiography.
RESULTS: Thirteen patients (32.5%) had silent myocardial ischaemia. NT-proBNP levels were significantly higher in these patients (181.1 ± 43.8 versus 55.2 ± 9.7 pg/mL, p < 0.005) but HbA(1c), lipid profiles, and creatinine were similar in the two groups. Moreover, log NT-proBNP was identified as an independent predictor of silent myocardial ischaemia (R(2) = 0.502, p < 0.05) after adjustment for HbA(1c), creatinine, albuminuria, hypertension, hyperlipidaemia, or smoking. After stratifying patients by NT-proBNP, the upper tertile compared to the lowest tertile was significantly associated with silent myocardial ischaemia (odds ratio: 26.7, p < 0.05). Receiver operation characteristics analysis with a cut-off value of 52 pg/mL showed 92% sensitivity and 75% specificity for predicting silent myocardial ischaemia (positive predictive value 64.7%, negative predictive value 94.3%).
CONCLUSIONS: The outstandingly high negative predictive value of NT-proBNP enables us to focus on diabetic patients with occult coronary disease, independently of microalbuminuria.
Kumiko Hamano; Mariko Abe; Rieko Komi; Shuzo Kobayashi
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Diabetes/metabolism research and reviews     Volume:  26     ISSN:  1520-7560     ISO Abbreviation:  Diabetes Metab. Res. Rev.     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-09-30     Completed Date:  2011-01-27     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100883450     Medline TA:  Diabetes Metab Res Rev     Country:  England    
Other Details:
Languages:  eng     Pagination:  534-9     Citation Subset:  IM    
Department of Diabetes and Endocrinology, Shonan Kamakura General Hospital, Yamazaki, Kanagawa, Japan.
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MeSH Terms
Albuminuria / etiology
Biological Markers / blood,  urine
Coronary Angiography
Coronary Artery Disease / blood,  diagnosis*,  etiology,  radiography
Coronary Stenosis / blood,  diagnosis*,  etiology,  radiography
Creatinine / blood,  urine
Diabetes Mellitus, Type 2 / blood,  complications*
Diabetic Angiopathies / blood,  diagnosis*,  etiology,  radiography
Hemoglobin A, Glycosylated / analysis
Hyperlipidemias / blood,  complications
Hypertension / complications
Middle Aged
Myocardial Ischemia / blood,  diagnosis*,  etiology,  radiography
Natriuretic Peptide, Brain / blood*,  urine
Peptide Fragments / blood*,  urine
Prospective Studies
Risk Factors
Reg. No./Substance:
0/Biological Markers; 0/Hemoglobin A, Glycosylated; 0/Peptide Fragments; 0/hemoglobin A1c protein, human; 0/pro-brain natriuretic peptide (1-76); 114471-18-0/Natriuretic Peptide, Brain; 60-27-5/Creatinine

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