Yeung Andrea M, Huang Jingtong, Pandey Ambarish, Hashim Ibrahim A, Kerr David, Pop-Busui Rodica, Rhee Connie M, Shah Viral N, Bally Lia, Bayes-Genis Antoni, Bee Yong Mong, Bergenstal Richard, Butler Javed, Fleming G Alexander, Gilbert Gregory, Greene Stephen J, Kosiborod Mikhail N, Leiter Lawrence A, Mankovsky Boris, Martens Thomas W, Mathieu Chantal, Mohan Viswanathan, Patel Kershaw V, Peters Anne, Rhee Eun-Jung, Rosano Giuseppe M C, Sacks David B, Sandoval Yader, Seley Jane Jeffrie, Schnell Oliver, Umpierrez Guillermo, Waki Kayo, Wright Eugene E, Wu Alan H B, Klonoff David C
Diabetes Technology Society, Burlingame, CA, United States of America.
UT Southwestern Medical Center, Dallas, TX, United States of America.
Prog Cardiovasc Dis. 2023 Jul-Aug;79:65-79. doi: 10.1016/j.pcad.2023.05.002. Epub 2023 May 11.
Diabetes Technology Society assembled a panel of clinician experts in diabetology, cardiology, clinical chemistry, nephrology, and primary care to review the current evidence on biomarker screening of people with diabetes (PWD) for heart failure (HF), who are, by definition, at risk for HF (Stage A HF). This consensus report reviews features of HF in PWD from the perspectives of 1) epidemiology, 2) classification of stages, 3) pathophysiology, 4) biomarkers for diagnosing, 5) biomarker assays, 6) diagnostic accuracy of biomarkers, 7) benefits of biomarker screening, 8) consensus recommendations for biomarker screening, 9) stratification of Stage B HF, 10) echocardiographic screening, 11) management of Stage A and Stage B HF, and 12) future directions. The Diabetes Technology Society panel recommends 1) biomarker screening with one of two circulating natriuretic peptides (B-type natriuretic peptide or N-terminal prohormone of B-type natriuretic peptide), 2) beginning screening five years following diagnosis of type 1 diabetes (T1D) and at the diagnosis of type 2 diabetes (T2D), 3) beginning routine screening no earlier than at age 30 years for T1D (irrespective of age of diagnosis) and at any age for T2D, 4) screening annually, and 5) testing any time of day. The panel also recommends that an abnormal biomarker test defines asymptomatic preclinical HF (Stage B HF). This diagnosis requires follow-up using transthoracic echocardiography for classification into one of four subcategories of Stage B HF, corresponding to risk of progression to symptomatic clinical HF (Stage C HF). These recommendations will allow identification and management of Stage A and Stage B HF in PWD to prevent progression to Stage C HF or advanced HF (Stage D HF).
糖尿病技术协会召集了一个由糖尿病学、心脏病学、临床化学、肾脏病学和初级保健领域的临床专家组成的小组，以审查目前关于糖尿病患者（PWD）心力衰竭（HF）生物标志物筛查的证据，根据定义，这些患者有患HF的风险（A期HF）。本共识报告从以下几个方面回顾了PWD中HF的特征：1）流行病学，2）阶段分类，3）病理生理学，4）诊断生物标志物，5）生物标志物检测，6）生物标志物的诊断准确性，7）生物标志物筛查的益处，8）生物标志物筛查的共识建议，9）B期HF的分层，10）超声心动图筛查，11）A期和B期HF的管理，以及12）未来方向。糖尿病技术协会小组建议：1）使用两种循环利钠肽之一（B型利钠肽或B型利钠肽原N端前体）进行生物标志物筛查；2）在1型糖尿病（T1D）诊断后5年以及2型糖尿病（T2D）诊断时开始筛查；3）对于T1D，不早于30岁开始常规筛查（无论诊断年龄），对于T2D则在任何年龄开始筛查；4）每年筛查一次；5）在一天中的任何时间进行检测。该小组还建议，生物标志物检测异常可定义为无症状临床前期HF（B期HF）。这一诊断需要通过经胸超声心动图进行随访，以分类为B期HF的四个亚类之一，对应于进展为有症状临床HF（C期HF）的风险。这些建议将有助于识别和管理PWD中的A期和B期HF，以防止进展为C期HF或晚期HF（D期HF）。
