Influence of diabetes on natriuretic peptide thresholds in screening for Stage B heart failure |
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Authors: | Chris Watson Stephanie James Eoin O’Connell Joe Gallagher James O’Reilly Elaine Tallon |
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Affiliation: | 1. Wellcome-Wolfson Building, Centre for Experimental Medicine, Queen’s University Belfast, Belfast, Northern Ireland;2. Chronic Cardiovascular Disease Management Group, St Vincent’s University Hospital Healthcare Group, Dublin, Ireland;3. chris.watson@qub.ac.uk;5. Chronic Cardiovascular Disease Management Group, St Vincent’s University Hospital Healthcare Group, Dublin, Ireland;6. School of Medicine, University College Dublin, Belfield, Dublin, Ireland |
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Abstract: | Context: Natriuretic peptide (NP) has been shown to be an effective screening tool to identify patients with Stage B heart failure and to have clinical value in preventing heart failure progression. The impact of associated metabolic confounders on the screening utility of NP needs clarification.Objective: To assess the impact of diabetes mellitus (DM) on NP screening for asymptomatic Stage B heart failure.Materials and methods: The study population consisted of 1368 asymptomatic patients with cardiovascular risk factors recruited from general practice as part of the STOP-HF trial. B-type NP (BNP) was quantified at point-of-care.Results: BNP was found to be as accurate for detecting Stage B heart failure in DM patients compared to non-DM patients (AUC 0.75 [0.71,0.78] and 0.77 [0.72,0.82], respectively). However, different BNP thresholds are required to achieve the same level of diagnostic sensitivity in DM compared with non-DM patients. To achieve 80% sensitivity a difference of 5-ng/L lower is required for patients with DM.Conclusion: Although a significantly different BNP threshold is detected for patients with DM, the BNP concentration difference is small and unlikely to warrant a clinically different diagnostic threshold. |
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Keywords: | B-type natriuretic peptide cardiac biomarker cardiovascular disease diabetes mellitus ventricular dysfunction |
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