N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) for predicting silent myocardial ischaemia in type 2 diabetes mellitus independent of microalbuminuria.
Journal - Diabetes/metabolism research and reviews
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 consecutively recruited forty 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) levels, lipid profiles, and creatinine levels 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. Copyright (c) 2010 John Wiley & Sons, Ltd.
Associations of renal vascular resistance with albuminuria and other macroangiopathy in type 2 diabetic patients.
Journal - Diabetes care (United States )
OBJECTIVE: Albuminuria can be caused by endothelial dysfunction as a result of ischemic nephropathy rather than classic diabetic nephropathy. We studied whether renal vascular resistance (resistive index [RI]) of the main renal arteries could be associated with albuminuria and further assessed the relationship between RI and aorta stiffness measured by brachial-ankle pulse-wave velocity (baPWV). RESEARCH DESIGN AND METHODS: We consecutively studied 150 patients with type 2 diabetes and the absence of clinically overt renal artery stenosis. Renal function expressed as the estimated glomerular filtration rate (eGFR) was calculated using the modified formula of modification of diet in renal disease (MDRD). The RI [(peak systolic velocity -end-diastolic velocity)/peak systolic velocity] was measured with duplex Doppler ultrasonography. RESULTS: When the presence of albuminuria (uAlb) was defined as urinary albumin-to-creatinine ratio (microg/mg x creatinine) >30, mean RI [(left RI + right RI)/2] was significantly higher in uAlb, compared with that in patients without uAlb. RI had significant associations with age (r = 0.398, P < 0.0001), diastolic blood pressure (r = -0.398, P < 0.0001), eGFR (r = -0.373, P < 0.0001), and baPWV (r = 0.223, P < 0.05), respectively. Multivariate logistic regression analysis showed that increased RI when defined as RI >0.72 (median) was significantly associated with age (P < 0.01, 95%CI 1.02-1.19), diastolic blood pressure (P < 0.01, 0.86-0.97), and uAlb (P < 0.01, 1.53-15.46), respectively. Moreover, RI was an independent risk factor for uAlb after adjustment of both diastolic blood pressure and eGFR. CONCLUSIONS: Renal vascular resistance was associated with albuminuria and aorta stiffness. Increased RI may imply the presence of any type of underlying renal damage, including ischemic nephropathy.
|ISSN : ||1935-5548|
|Mesh Heading : ||Aged Albuminuria Blood Pressure Creatinine Diabetes Mellitus, Type 2 Diabetic Angiopathies Glomerular Filtration Rate Humans Lipids Male Middle Aged Pulse Renal Artery Renal Circulation Ultrasonography, Doppler, Duplex blood physiopathology ultrasonography blood physiopathology ultrasonography|
|Mesh Heading Relevant : ||Vascular Resistance epidemiology complications epidemiology physiology|