B-type natriuretic peptide efficacy compared to fragmented QRS for diastolic dysfunction screening in patients with type 2 diabetes  

作　　者：Kunimasa Yagi Daisuke Chujo Isao Usui Jian-Hui Liu Atsushi Nohara Asako Enkaku Shirozu Akiko Takikawa Hisae Honoki Shiho Fujisaka Hideki Origasa Hayato Tada 

机构地区：[1]Department of Internal Medicine,Kanazawa Medical University Hospital,Kahoku 920-0293,Ishikawa,Japan [2]Center for Clinical and Translational Research,Toyama University Hospital,Toyama 930-0152,Toyama,Japan [3]Department of Endocrinology and Metabolism,Dokkyo Medical University,Utsunomiya 321-0293,Tochigi,Japan [4]Department of Cardiology,Ningbo Medical Center of Lihuili Hospital,Ningbo 315041,Zhejiang Province,China [5]Department of Clinical Genetics,Ishikawa Prefectural Central Hospital,Kanazawa 920-8530,Ishikawa,Japan [6]The First Department of Internal Medicine,Toyama University Hospital,Toyama 930-0152,Toyama,Japan [7]Data Science and AI Innovation Research Promotion Center,Institute of Statistical Mathematics,Shiga University,Hikone 525-0034,Shiga,Japan [8]Division of Cardiovascular Medicine,Kanazawa University,Graduate School of Medicine,Kanazawa 920-8640,Ishikawa,Japan

出　　处：《World Journal of Diabetes》2025年第4期84-95,共12页世界糖尿病杂志(英文)

基　　金：Supported by the JSPS KAKENHI,No.JP21K10300 and No.JP24K02714.

摘　　要：BACKGROUND Early diagnosis of left ventricular diastolic dysfunction(LVDD)is essential for preventing heart failure.B-type natriuretic peptide(BNP)is a viable marker for predicting LVDD,as elevated BNP levels have been associated with worsening LVDD in patients with diabetes over time.However,the utility of BNP as a diagnostic marker in diabetes is controversial,as BNP levels are often low in overweight individuals.AIM To examine the effectiveness of BNP levels and fragmented QRS(fQRS)on electrocardiography for diagnosing LVDD in patients with type 2 diabetes.METHODS This retrospective cohort study included 303 patients with type 2 diabetes(67.4±12.3 years old)with preserved ejection fraction(EF)≥50%admitted to Toyama University Hospital for glycemic management and comorbidity evaluation between November 2017 and April 2021.All participants underwent plasma BNP measurement,electrocardiography,and echocardiography.Cardiologists who were blinded to the BNP results assessed the electrocardiograms and echocardiograms.Subgroup analyses were conducted for overweight individuals.RESULTS Receiver operating characteristic(ROC)curve analysis determined optimal BNP cut-off values of 34.8 pg/mL and 7.2 pg/mL for diagnosing LVDD in non-overweight[area under the ROC curve(AUC):0.70]and overweight(AUC:0.55)groups,respectively(P=0.040).In the overweight subgroup,fQRS showed greater diagnostic accuracy for LVDD(AUC:0.67),indicating moderate diagnostic utility compared with the low performance of the BNP cutoff of 35 pg/mL(AUC:0.52)(P=0.010).Multivariate analyses confirmed that fQRS was superior to BNP for LVDD diagnosis regardless of the patient’s weight.CONCLUSION A BNP level≥35 pg/mL in non-overweight individuals may be a reliable LVDD marker.Additionally,fQRS was more effective than BNP in diagnosing LVDD irrespective of the patient’s weight.fQRS can complement BNP in the early detection of LVDD,especially in overweight patients,potentially improving early detection and mitigating progression to heart failure with pre

关 键 词：B-type natriuretic peptide Diastolic dysfunction Fragmented QRS Heart failure with preserved ejection fraction OVERWEIGHT Type 2 diabetes 

分 类 号：R587.1[医药卫生—内分泌]