Abstract
BACKGROUND
Prevention of heart failure (HF) has been recognized as an urgent public health need. International guidelines recommend natriuretic peptide biomarker-based screening for patients at high HF risk to allow early detection and intervention to delay HF progression and mortality. Little has been reported the incorporation of screening procedure to existing clinical practice. The objective of the study was to describe the opportunistic screening of left ventricular dysfunction in patients with type 2 diabetes mellitus (DM).
METHOD
This was a prospective screening study at the DM complication screening center.
RESULTS
Between 2018 and 2019, 1,132 consecutive DM patients with no prior history of HF or atrial fibrillation (AF) attending regular complication screening were invited to participate. Of these, 89 patients refused or failed to complete the screening. The final analysis included 1,043 patients (age: 63.7±12.4 years; male: 56.3%). The mean HbA1c was 7.25±1.34%. There were 81.8% patients with concomitant hypertension, 31.1% with coronary artery disease, 8.0% with previous stroke, and 5.5% with peripheral artery disease. Furthermore, 45.7% patients had diabetic retinopathy, 33.6% had peripheral neuropathy, and 30.7% had chronic kidney disease (CKD) stage 3-5. At the screening session, 43 patients (4.1%) had an elevated NT-proBNP concentration above the age-specific diagnostic thresholds for HF, and 43 patients (4.1%) had newly detected AF. The prevalence of elevated NT-proBNP concentration increased with age from 0.85% in patients aged <50 years to 7.14% in those aged 70-79 years and worsening kidney function from 0.43% in patients with CKD stage 1 to 42.86% in CKD stage 5. In multivariate logistic regression, male gender (OR: 3.67 (1.47-9.16), p =0.005*), prior stroke (OR: 3.26 (1.38-7.69), p= 0.007*), CKD ( p <0.001*), and newly detected AF (OR: 7.02 (2.65-18.57), p <0.001*) were significantly associated with elevated NT-proBNP concentration. Amongst patients with elevated NT-proBNP concentration, their mean left ventricular ejection fraction (LVEF) was 51.4 ± 14.7%, and 45% patients had a LVEF <50%.
CONCLUSION
Both NT-proBNP and ECG screening could be easily implemented. Our findings demonstrate systemic screening allows detection of early phase HF and asymptomatic AF in patients with DM, thereby facilitating the implementation of preventive measure to improve the long-term outcomes.
Subclinical left ventricular dysfunction and 10-year outcomes in type 2 diabetes mellitus
